Thrombectomy for late occlusion of high flow extracranial–intracranial saphenous vein bypass graft after 27 years of patency

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...

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Bibliographic Details
Published in:BMJ case reports 2018-03, Vol.2018, p.bcr-2017-013670
Main Authors: Silva, Michael A, Alcedo Guardia, Rodolfo E, Aziz-Sultan, Mohammad Ali, Patel, Nirav J
Format: Article
Language:English
Subjects:
Aneurysms
Carotid arteries
Case reports
Cerebral Angiography
Cerebral Revascularization - methods
Diffusion Magnetic Resonance Imaging
Family medical history
Female
Humans
Information sharing
Intracranial Aneurysm - complications
Intracranial Aneurysm - diagnostic imaging
Intracranial Aneurysm - physiopathology
Intracranial Aneurysm - therapy
Ischemic Stroke
Medical imaging
Middle Aged
Neurologic Examination
Neurosurgery
Paresthesia - diagnostic imaging
Paresthesia - etiology
Paresthesia - physiopathology
Patients
Postoperative Complications - diagnostic imaging
Postoperative Complications - physiopathology
Postoperative Complications - therapy
Saphenous Vein - transplantation
Skin & tissue grafts
Stroke
Treatment Outcome
Vascular Grafting - adverse effects
Vascular Grafting - methods
Vascular Patency
Veins & arteries
Citations: Items that this one cites
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Summary: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.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2017-013670