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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3617_Библиотеки_им_академика_М_И_Перельмана
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High-Flow Cervical Carotid Artery–to–MCA Bypass 175
Fig. 7.4b Right-sided intraoperative view of the infratemporal fossa shows temporary clips on the anterior loop of the
IMA adjacent to V2. (Photograph courtesy of Saleem I. Abdulrauf, MD, FACS.)
Fig. 7.4c Proximal end of the radial artery graft is anastomosed to the IMA. (Photograph courtesy of Saleem I.
Abdulrauf, MD, FACS.)
Fig. 7.4d Radial artery interposition graft is visible between the IMA and the M2 segment of the MCA. (Photograph
courtesy of Saleem I. Abdulrauf, MD, FACS.)
176 Color Atlas of Cerebral Revascularization
Fig. 7.4e Artist’s rendering of Abdulrauf bypass. The
interposition radial artery graft is anastomosed from the
IMA, side-to-end, and to the M2, end-to-side. (Courtesy of
Saleem I. Abdulrauf, MD, FACS.)
Fig. 7.4f Intraoperative ICG angiogram confi rms patency
of the radial artery graft. (Courtesy of Saleem I. Abdulrauf,
MD, FACS.)
High-Flow Cervical Carotid Artery–to–MCA Bypass 177
Fig. 7.4g Intraoperative angiogram
shows the bypass formed by the
interposition radial artery graft from
the IMA to M2. (Courtesy of Saleem I.
Abdulrauf, MD, FACS.)
Fig. 7.4h Postoperative threedimensional reconstruction CT angiogram
shows the patent radial artery bypass
graft between the IMA and M2. (Courtesy
of Saleem I. Abdulrauf, MD, FACS.)
178 Color Atlas of Cerebral Revascularization
Case 7-5
Diagnosis: Giant right PCoA aneurysm after previ-
ous coiling
Bypass: Right ECA-to-MCA with radial artery graft
Approach: Right orbitozygomatic and anterior
cervical
Fig. 7.5a Anteroposterior MR angiogram shows a
complex, partially thrombosed aneurysm ( arrow ) in
the region of the right PCoA.
Fig. 7.5b Coronal and axial MR images demonstrate the size of the
aneurysm ( arrows ). (Axial image used with permission from Journal of
Neurosurgery .)
c
Fig. 7.5c–e Anteroposterior ( c ) and lateral
( d, e ) angiograms show the partially coiled
PCoA aneurysm, which has enlarged,
causing CN III palsy. ( Fig. 7.5e used with
e
permission from Journal of Neurosurgery .)
d
180 Color Atlas of Cerebral Revascularization
Fig. 7.5f Intraoperative photograph shows the right ICA with a large PCoA aneurysm. Because of the wide neck of the
aneurysm and the presence of the stent and coils, the patient had been prepared for a radial artery graft.
Fig. 7.5g A fenestrated clip has been placed on the neck of the aneurysm with the goal of occluding the most distal
part of its neck. Then a straight clip would have been placed to close the opening of the fenestration.
Fig. 7.5h The neck of the aneurysm has ruptured.
High-Flow Cervical Carotid Artery–to–MCA Bypass 181
Fig. 7.5i Temporary clips are placed proximally and distally on the ICA to control the hemorrhage.
Fig. 7.5j Multiple clips have been placed on the ICA to occlude the neck of the aneurysm. The prongs of the stent are visible.
Fig. 7.5k After the multiple clips were placed on the ICA, the bleeding is controlled. Every attempt was made to
preserve the origin of the AChoA.
182 Color Atlas of Cerebral Revascularization
Fig. 7.5l The right M2 branch is prepared for a bypass.
Fig. 7.5m A temporary clip is placed on the M2 branch selected for the bypass.
Fig. 7.5n The radial artery graft is being anastomosed end-to-side to the recipient MCA vessel.
Fig. 7.5o The anastomosis is completed.
High-Flow Cervical Carotid Artery–to–MCA Bypass 183
Fig. 7.5p After the radial artery graft was tunneled subcutaneously, it is anastomosed end-to-side to the ECA.
Fig. 7.5q ICG angiogram confi rms patency of the bypass
( arrow ).
184 Color Atlas of Cerebral Revascularization
Fig. 7.5r Intraoperative angiogram confi rms excellent
patency of the radial artery graft bypass. From the start of the
procedure, the patient was placed in a barbiturate coma to
EEG burst suppression.
Fig. 7.5s Postoperative CT scans show no infarction.
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