Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Neurointerv Surg. 2018 Nov;10(11):e27. doi: 10.1136/neurintsurg-2017-013670.rep. Epub 2018 Apr 7.
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.
高流量颅外-颅内（EC-IC）旁路移植术采用隐静脉移植物（SVG），已在对药物治疗有抗性的巨大后循环动脉瘤患者中使用了 40 多年，其长期通畅率很高。我们报告了一位患者的病例，她于 1989 年接受了颈外动脉（ECA）-大脑后动脉 SVG 旁路移植术，27 年后出现感觉异常和意识混乱，发现 SVG 旁路移植术部分闭塞和基底动脉闭塞。通过部分血栓形成的移植物对基底动脉闭塞进行机械血栓切除术，这是首例通过高流量后循环 EC-IC SVG 进行此类手术的报告，导致患者的神经检查得到改善。27 年，这是报告的最长 SVG 旁路移植术血栓形成延迟时间，突出了这些移植物的长期通畅性以及通过闭塞旁路移植物进行血栓切除术的可行性。
