• Hidetoshi Matsukawa, Rokuya Tanikawa, Hiroyasu Kamiyama, Toshiyuki Tsuboi, Kosumo Noda, Nakao Ota, Shiro Miyata, Rihei Takeda, and Sadahisa Tokuda.
• Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
• Neurosurgery. 2017 Oct 1; 81 (4): 672-679.

BackgroundAlthough the extracranial-to-intracranial high-flow bypass (EC-IC HFB) continues to be indispensable for complex aneurysms, the risk factors for the graft occlusion and whether the graft size changes after the bypass have not been well established.ObjectiveTo evaluate the risk factors for the graft occlusion and to confirm whether graft diameters changed over time.MethodsThe data of 75 patients who suffered from complex internal carotid artery (ICA) aneurysms and were treated by EC-IC HFB using radial artery graft (RAG) or saphenous vein graft (SVG) with therapeutic ICA occlusion were evaluated. Clinical and radiological characteristics were compared in patients with and without the graft occlusion by the log-rank test. Graft diameters measured preoperatively, postoperatively, at 6 months, and at 1 year were compared by paired t-test.ResultsDuring a follow-up period (median 26.2 months), graft occlusions were seen in 4 patients (5.3%), and these were the SVGs. Only SVG was related to graft occlusion (P < .001). There was a significant increase with time in RAG diameters (preoperative, 3.1 ± 0.41 mm; postoperative, 3.6 ± 0.65 mm; 6 months, 4.3 ± 1.0 mm; 1 year, 4.4 ± 1.0 mm), while there were no significant diameter changes in SVGs.ConclusionThe present study showed that the SVG was related to the graft occlusion and RAGs gradually enlarged. Unless Allen test is negative, RAG may be better to be used as a graft in EC-IC HFB if therapeutic ICA occlusion is needed.Copyright © 2017 by the Congress of Neurological Surgeons

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