Neurosurgery
-
Cerebral revascularization with extracranial-to-intracranial bypass is often required during the surgical treatment of complex intracranial aneurysms. This report is the first in which a vertebral artery (VA)-to-middle cerebral artery (MCA) bypass in conjunction with endovascular coil embolization is used in the successful treatment of a giant intracranial aneurysm. ⋯ This report describes a safe and definitive treatment option for a giant intracranial ICA aneurysm using a posterior-to-anterior circulation (VA-MCA) bypass, followed by endovascular coil embolization in a patient with previous ligation of the common carotid artery. VA-MCA high-flow saphenous vein bypass followed by coil embolization is a useful technique that is especially valuable in the subset of giant aneurysm patients who have previously been treated by carotid ligation.
-
Argatroban is a synthetic direct thrombin inhibitor. We applied argatroban locally during carotid endarterectomy to prevent local mural thrombus formation. Although local delivery of argatroban is expected to be effective for inhibition of mural clot formation, there is no report of the evaluation of its clinical effectiveness or local drug concentration in humans. ⋯ The results suggest that direct local application of argatroban during carotid endarterectomy for at least 3 minutes may deliver high local tissue levels. Argatroban may be effective for prevention of perioperative embolic cerebral complications during carotid endarterectomy.