Endovascular intervention for delayed stenosis of extracranial–intracranial bypass saphenous vein grafts
- Omar Qahwash1,
- Ali Alaraj1,
- Victor Aletich1,
- Fady T Charbel1,
- Ketan R Bulsara2,
- Winson Ho2,
- Tbor Valyi-Nagy3,
- Sepideh Amin-Hanjani3
- 1Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
- 2Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
- 3University of Illinois, Chicago, Illinois, USA
- Correspondence to Dr S Amin-Hanjani, Department of Neurosurgery, University of Illinois, Chicago, IL 60612, USA;
Contributors OQ: manuscript preparation, data acquisition and data analysis; AA: study design, data analysis and manuscript editing; VA: study concept, data analysis and manuscript editing; FTC: study concept and manuscript review; KRB: literature research, manuscript preparation and review; WH: literature review and manuscript preparation; TV-N: data acquisition and manuscript review; SA-H: study design, data analysis, manuscript preparation and editing, and guarantor of the integrity of the entire study.
- Received 18 November 2011
- Revised 14 March 2012
- Accepted 15 March 2012
- Published Online First 4 April 2012
Purpose Bypass graft stenosis is an uncommon but significant issue which can be encountered following extracranial–intracranial (EC–IC) bypass surgery and carries significant potential for morbidity and mortality. Angioplasty for graft stenosis (with or without stenting) has been extensively discussed in the cardiothoracic literature but its application for neurosurgical purposes has not been well documented.
Methods Cases of EC–IC bypass undergoing endovascular intervention for graft stenosis were retrospectively reviewed; a literature search was performed. Diagnosis, pathology and indications for intervention were reviewed.
Results Three patients underwent 13 endovascular interventions for EC–IC saphenous vein graft stenosis. The indication for the initial bypass was an unsecured intracranial aneurysm in all cases, using an interposition saphenous vein graft. The initial endovascular procedure was needed 9–23 weeks after the bypass surgery, a timeframe suggestive of intimal hyperplasia as the underlying etiology of stenosis. There were nine cases of angioplasty alone, three with stent placement and one case in which vasodilators were infused. Non-invasive phase contrast quantitative MR angiography was effective in predicting graft stenosis. Despite intervention, two grafts ultimately occluded and a third has remained patent only after multiple angioplasties and placement of a drug eluting coronary stent.
Conclusion Although rare, bypass graft stenosis can occur in the subacute period, and likely represents a flow related venopathy. Given the challenges of re-do bypass surgery, endovascular intervention is an attractive treatment option. However, although repeated interventions with diligent follow-up may allow graft salvage, failure of endovascular intervention can also ultimately result in graft occlusion.
Competing interests None.
Patient consent The patients in this report fall under an institutional IRB approved protocol for chart review which includes waiver of consent.
Ethics approval Ethics approval was provided by the institutional review board of University of Illinois, Chicago.
Provenance and peer review Not commissioned; externally peer reviewed.