• Edward Chu Yin Lun YL Department of Radiology, Queen Mary Hospital, Hong Kong, China. Electronic address: edchu.radiology@gmail.com., Anderson Chun-On Tsang, Chun-Pong Tsang Frederick F Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, Hong Kong, China., Raymand Lee, and Wai Man Lui.
• Department of Radiology, Queen Mary Hospital, Hong Kong, China. Electronic address: edchu.radiology@gmail.com.
• World Neurosurg. 2020 Feb 1; 134: 460-464.

BackgroundBypass graft stenosis following extracranial-intracranial bypass surgery carries significant risks for morbidity and mortality. In case of graft failure, treatment options include surgical revision and endovascular intervention. Whereas endovascular intervention following coronary artery bypass is well established, the role of endovascular therapy in cerebral bypass conduits is rarely reported. We present a case of extracranial-intracranial bypass graft stenosis in the early postoperative period that was successfully treated by endovascular angioplasty and stenting.Case DescriptionA middle-aged patient presented with a malignant skull base tumor with internal carotid artery invasion. Extracranial-intracranial bypass surgery was performed for flow preservation before tumor removal. Autologous radial artery was used as the bypass graft conduit. Symptomatic graft stenosis was encountered in the immediate postoperative period. Treatments in the form of intra-arterial vasodilator infusion and balloon angioplasty led to only minor flow improvement. The narrowing was eventually salvaged by endovascular stenting. Good clinical and radiologic outcomes were achieved at 6-month follow-up.ConclusionsEndovascular intervention is a feasible treatment option in management of graft stenosis after cerebral revascularization surgery. Our case adds evidence to the safety and role of endovascular intervention in early cerebral bypass conduit failure. In addition, endovascular stenting can be considered as a salvage option for cases that are refractory to angioplasty.Copyright © 2019 Elsevier Inc. All rights reserved.

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