Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
J Neurointerv Surg. 2013 May;5(3):231-6. doi: 10.1136/neurintsurg-2011-010202. Epub 2012 Apr 4.
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.
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.
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.
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.
颅外-颅内（EC-IC）旁路手术后吻合口狭窄虽不常见，但却是一个严重的问题，可能会导致严重的发病率和死亡率。血管成形术治疗吻合口狭窄（伴或不伴支架置入）在心胸外科学文献中已有广泛讨论，但在神经外科中的应用尚未得到很好的记录。
回顾性分析接受血管内介入治疗吻合口狭窄的 EC-IC 旁路手术病例；并进行文献检索。回顾了诊断、病理学和介入治疗的适应证。
3 例患者因 EC-IC 隐静脉桥吻合口狭窄行 13 次血管内介入治疗。所有病例的初始旁路指征均为未破裂颅内动脉瘤，使用了间置隐静脉桥。最初的血管内操作在旁路手术后 9-23 周进行，这一时间范围提示狭窄的潜在病因是内膜增生。9 例单独行血管成形术，3 例加支架置入，1 例注入血管扩张剂。非侵入性相位对比定量 MR 血管造影术能有效预测吻合口狭窄。尽管进行了干预，但最终有 2 个桥接闭塞，第 3 个桥接仅在多次血管成形术和放置药物洗脱冠状动脉支架后才保持通畅。
虽然罕见，但吻合口狭窄可在亚急性期发生，可能代表一种与血流相关的静脉病。鉴于再次旁路手术的挑战，血管内介入治疗是一种有吸引力的治疗选择。然而，尽管通过反复的介入治疗和密切的随访可以挽救桥接，但血管内介入治疗的失败也可能最终导致桥接闭塞。
