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CASE REPORT
Thrombectomy for late occlusion of high flow extracranial–intracranial saphenous vein bypass graft after 27 years of patency
  1. Michael A Silva,
  2. Rodolfo E Alcedo Guardia,
  3. Mohammad Ali Aziz-Sultan,
  4. Nirav J Patel
  1. Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Nirav J Patel, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA; npatel40{at}bwh.harvard.edu

Abstract

High flow extracranial–intracranial (EC-IC) bypass with a saphenous vein graft (SVG) has been used for more than 40 years in patients with giant aneurysms of the posterior circulation refractory to medical management, and has demonstrated high long term patency rates. We report the case of a patient treated with external carotid artery (ECA)–posterior cerebral artery SVG bypass in 1989 who presented 27 years later with paresthesias and confusion, and was found to have partial occlusion of her SVG bypass graft and a basilar occlusion. She was treated with mechanical thrombectomy of the basilar occlusion via the partially thrombosed graft, the first report of such a procedure through a high flow posterior circulation EC-IC SVG, resulting in improvement of the patient’s neurologic examination. At 27 years, this is the longest reported delay in thrombosis of a high flow SVG bypass graft, highlighting the long term patency of these grafts and the feasibility of thrombectomy through occluded bypass grafts.

  • thrombectomy
  • technique
  • stroke
  • intervention
  • ct angiography

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Footnotes

  • Republished with permission from BMJ Case Reports Published March 8, 2018; doi: 10.1136/bcr-2017-013548.rep

  • Contributors MAS analyzed the data, compiled the figures, and drafted and revised the paper. REAG treated the patient in the study, collected and analyzed the data, and revised the manuscript. MAA-S treated the patient and revised the paper. NJP oversaw the study, treated the patient in the study, collected and analyzed the data, compiled the figures, and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The technical methodology has been disclosed in its entirety within the case report. The representative case images are not relevant for data sharing.

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