Treatment of @entity438 with saphenous vein extracranial-to-intracranial bypass grafting: indications, operative technique, and results in 29 XXXX .

@entity1 @entity438 @entity1269 @entity1805 @entity439 @entity715 @entity204 @entity385
OBJECTIVE: The treatment of @entity438 is a challenge because of the limitations and difficulty of direct surgical clipping and endovascular coiling. We describe the indications, surgical technique, and complications of saphenous vein extracranial-to-intracranial bypass grafting followed by acute parent vessel occlusion in the management of these difficult lesions. METHODS: Between January 1990 and December 1999, 29 @entity1 with @entity438 underwent 30 saphenous vein bypass grafts followed by immediate parent vessel occlusion. There were 11 @entity1 and 18 @entity1 with a mean follow-up period of 62 months. Twenty-five @entity1 harbored @entity439 involving the internal carotid artery, 2 had @entity438 , and 2 had @entity439 in the basilar artery. Serial cerebral or magnetic resonance angiograms were obtained to assess graft patency and @entity439 . RESULTS: All 30 @entity439 were excluded from the cerebral circulation, with 28 vein grafts remaining patent. Two @entity1 had graft occlusions: one because of poor runoff and the other because of misplacement of a cranial pin during a bypass procedure on the contralateral side. Other surgical complications included one @entity204 from a large @entity385 , @entity1805 from @entity715 of an anterior choroidal artery after internal carotid artery occlusion, and @entity1269 from a presumed perforator @entity715 adjacent to a basilar @entity439 . CONCLUSION: With appropriate attention to surgical technique, a saphenous vein extracranial-to-intracranial bypass followed by acute parent vessel occlusion is a safe and effective method of treating @entity438 . A high rate of graft patency and adequate cerebral blood flow can be achieved. @entity715 of perforating arteries caused by altered blood flow hemodynamics after parent vessel occlusion may be a continuing source of complications.
