title: Viability of anastomoses with coupler in extra-intracranial bypass: cadaveric study.
abstract: BACKGROUND
  The time required to perform an anastomosis in extra-intracranial bypass is approximately 20 to 60 minutes. The search for alternative methods to reduce the ischemic time remains vital.
  
  
  OBJECTIVE
  To evaluate Coupler anastomosis for extra-intracranial bypass in cadavers.
  
  
  METHODS
  In 8 fresh adult cadavers, the saphenous vein and radial artery were used as donor vessels. The superficial temporal and the extracranial internal and external carotid arteries were dissected. A wide craniotomy with a sylvian fissure opening was performed, exposing the middle cerebral and supraclinoid internal carotid arteries. The Coupler devices were tested in all 8 cadavers. The diameter of the donor and recipient vessels as well as the time required to perform the anastomosis were measured. Bypass permeability was evaluated by injecting saline solution under pressure, checking for leaks.
  
  
  RESULTS
  The anastomoses were successfully performed in all specimens. The size of the head of the fitting Coupler required the performance of a wide craniotomy (6 × 6 cm) and a wide opening of the sylvian fissure. The time required to perform each anastomosis ranged from 4 to 7 minutes, being easier with the radial artery than with the saphenous vein.
  
  
  CONCLUSIONS
  Coupler devices are helpful to perform the anastomoses, because they significantly reduce ischemia time. Their use is easier at the M1 segment, just before the bifurcation and after takeoff of the lenticulostriate arteries, and in the M2 segment. It would be advisable to have a smaller coupling system, allowing maneuverability in the deeper areas where space is limited.
authors.affiliation: *Hospital General Universitario de Valencia, Valencia, Spain; ‡Instituto de Medicina Legal de Valencia (IMLV), Valencia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Vanaclocha
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Herrera
authors.forename: José María
authors.initials: JM
authors.lastname: Ortiz
authors.forename: Francisco
authors.initials: F
authors.lastname: Verdu
authors.forename: Laurabel
authors.initials: L
authors.lastname: Gozalbes
authors.forename: Moises
authors.initials: M
authors.lastname: Sanchez
authors.forename: Marlon
authors.initials: M
authors.lastname: Rivera
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000295:instrumentation*; D002102:Cadaver; D002548:Cerebral Revascularization / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged