• Alexander Spiessberger, Fabio Strange, Basil Erwin Gruter, Stefan Wanderer, Daniela Casoni, Philipp Gruber, Michael Diepers, Luca Remonda, Javier Fandino, Javier Añon, and Serge Marbacher.
• 1Department of Neurosurgery, Kantonsspital Aarau.
• J. Neurosurg. 2021 Jun 1; 134 (6): 184618511846-1851.

ObjectiveTemporary parent vessel occlusion performed to establish a high-flow interpositional bypass carries the risk of infarcts. The authors investigated the feasibility of a novel technique to establish a high-flow bypass without temporary parent vessel occlusion in order to lower the risk of ischemic complications.MethodsIn 10 New Zealand white rabbits, a carotid artery side-to-end anastomosis was performed under parent artery patency with a novel endovascular balloon device. Intraoperative angiography, postoperative neurological assessments, and postoperative MRI/MRA were performed to evaluate the feasibility and safety of the novel technique.ResultsA patent anastomosis was established in 10 of 10 animals; 3 procedure-related complications occurred. No postoperative focal neurological deficits were observed. The MRI/MRA findings include no infarcts and bypass patency in 50% of the animals.ConclusionsThe authors demonstrated the feasibility of an endovascular assisted, nonocclusive high-flow bypass. Future refinement of the device and technique in an animal model is necessary to lower the complication rate and increase patency rates.

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