Hänggi Daniel, Reinert Michael, Steiger Hans-Jakob
Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany.
J Neurosurg. 2009 Jul;111(1):181-7. doi: 10.3171/2009.2.JNS081388.
Preliminary experience with the C-Port Flex-A Anastomosis System (Cardica, Inc.) to enable rapid automated anastomosis has been reported in coronary artery bypass surgery. The goal of the current study was to define the feasibility and safety of this method for high-flow extracranial-intracranial (EC-IC) bypass surgery in a clinical series.
In a prospective study design, patients with symptomatic carotid artery (CA) occlusion were selected for C-Port-assisted high-flow EC-IC bypass surgery if they met the following criteria: 1) transient or moderate permanent symptoms of focal ischemia; 2) CA occlusion; 3) hemodynamic instability; and 4) had provided informed consent. Bypasses were done using a radial artery graft that was proximally anastomosed to the superficial temporal artery trunk, the cervical external, or common CA. All distal cerebral anastomoses were performed on M2 branches using the C-Port Flex-A system.
Within 6 months, 10 patients were enrolled in the study. The distal automated anastomosis could be accomplished in all patients; the median temporary occlusion time was 16.6+/-3.4 minutes. Intraoperative digital subtraction angiography (DSA) confirmed good bypass function in 9 patients, and in 1 the anastomosis was classified as fair. There was 1 major perioperative complication that consisted of the creation of a pseudoaneurysm due to a hardware problem. In all but 1 case the bypass was shown to be patent on DSA after 7 days; furthermore, in 1 patient a late occlusion developed due to vasospasm after a sylvian hemorrhage. One-week follow-up DSA revealed transient asymptomatic extracranial spasm of the donor artery and the radial artery graft in 1 case. Two patients developed a limited zone of infarction on CT scanning during the follow-up course.
In patients with symptomatic CA occlusion, C-Port Flex-A-assisted high-flow EC-IC bypass surgery is a technically feasible procedure. The system needs further modification to achieve a faster and safer anastomosis to enable a conclusive comparison with standard and laser-assisted methods for high-flow bypass surgery.
已有报道称在冠状动脉搭桥手术中使用C-Port Flex-A吻合系统(Cardica公司)进行快速自动吻合的初步经验。本研究的目的是在临床系列中确定这种方法用于高流量颅外-颅内(EC-IC)搭桥手术的可行性和安全性。
在一项前瞻性研究设计中,有症状的颈动脉(CA)闭塞患者若符合以下标准则被选入C-Port辅助高流量EC-IC搭桥手术:1)短暂性或中度永久性局灶性缺血症状;2)CA闭塞;3)血流动力学不稳定;4)已签署知情同意书。搭桥手术使用桡动脉移植物,近端吻合至颞浅动脉主干、颈外动脉或颈总动脉。所有远端脑吻合均使用C-Port Flex-A系统在M2分支上进行。
6个月内,10名患者纳入研究。所有患者均能完成远端自动吻合;中位临时闭塞时间为16.6±3.4分钟。术中数字减影血管造影(DSA)证实9例患者搭桥功能良好,1例吻合口功能为一般。围手术期有1例主要并发症,因硬件问题形成假性动脉瘤。除1例患者外,其余患者术后7天DSA显示搭桥血管通畅;此外,1例患者在大脑外侧裂出血后因血管痉挛出现晚期闭塞。1周随访DSA显示1例患者供体动脉和桡动脉移植物出现短暂无症状颅外痉挛。2例患者在随访过程中CT扫描发现梗死灶范围有限。
对于有症状的CA闭塞患者,C-Port Flex-A辅助高流量EC-IC搭桥手术在技术上是可行的。该系统需要进一步改进以实现更快、更安全的吻合,从而能够与高流量搭桥手术的标准方法和激光辅助方法进行决定性比较。