title: Graft Occlusion and Graft Size Changes in Complex Internal Carotid Artery Aneurysm Treated by Extracranial to Intracranial Bypass Using High-Flow Grafts with Therapeutic Internal Carotid Artery Occlusion.
abstract: BACKGROUND
  Although the extracranial-to-intracranial high-flow bypass (EC-IC HFB) continues to be indispensable for complex aneurysms, the risk factors for the graft occlusion and whether the graft size changes after the bypass have not been well established.
  
  
  OBJECTIVE
  To evaluate the risk factors for the graft occlusion and to confirm whether graft diameters changed over time.
  
  
  METHODS
  The data of 75 patients who suffered from complex internal carotid artery (ICA) aneurysms and were treated by EC-IC HFB using radial artery graft (RAG) or saphenous vein graft (SVG) with therapeutic ICA occlusion were evaluated. Clinical and radiological characteristics were compared in patients with and without the graft occlusion by the log-rank test. Graft diameters measured preoperatively, postoperatively, at 6 months, and at 1 year were compared by paired t-test.
  
  
  RESULTS
  During a follow-up period (median 26.2 months), graft occlusions were seen in 4 patients (5.3%), and these were the SVGs. Only SVG was related to graft occlusion (P < .001). There was a significant increase with time in RAG diameters (preoperative, 3.1 ± 0.41 mm; postoperative, 3.6 ± 0.65 mm; 6 months, 4.3 ± 1.0 mm; 1 year, 4.4 ± 1.0 mm), while there were no significant diameter changes in SVGs.
  
  
  CONCLUSIONS
  The present study showed that the SVG was related to the graft occlusion and RAGs gradually enlarged. Unless Allen test is negative, RAG may be better to be used as a graft in EC-IC HFB if therapeutic ICA occlusion is needed.
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Matsukawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Rokuya
authors.initials: R
authors.lastname: Tanikawa
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Kamiyama
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Tsuboi
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Kosumo
authors.initials: K
authors.lastname: Noda
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Nakao
authors.initials: N
authors.lastname: Ota
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Miyata
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Rihei
authors.initials: R
authors.lastname: Takeda
authors.affiliation: Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Sadahisa
authors.initials: S
authors.lastname: Tokuda
mesh_terms: D000328:Adult; D000368:Aged; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D017534:Radial Artery / Q000473:pathology / Q000637:transplantation*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000473:pathology / Q000637:transplantation*; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: Cerebral revascularization; Graft occlusion; Intracranial aneurysm; Risk factors