Advanced

AJNR - American Journal of Neuroradiology

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Badie, B. Articles by Strother, C. M. Search for Related Content PubMed PubMed Citation Articles by Badie, B. Articles by Strother, C. M.

Intraoperative Sonographic Assessment of Graft Patency during Extracranial-intracranial Bypass

Behnam Badie^,a, Fred T. Lee Jr.^a, Myron A. Pozniak^a and Charles M. Strother^a

^a From the Departments of Neurological Surgery (B.B.) and Radiology (F.T.L., M.A.P., C.M.S.), University of Wisconsin School of Medicine, Madison, WI.

View larger version (92K): [in a new window]   FIG 1. Preoperative digital subtraction angiogram (left) and sagittal view MR image of the brain (right) show a partially thrombosed fusiform midbasilar artery aneurysm (arrows). Note the dominant left vertebral artery supplying the basilar artery

View larger version (57K): [in a new window]   FIG 2. Color and pulsed Doppler sonographic image obtained during superficial temporal artery bypass surgery. The anatomic structure coded in red is the superficial temporal artery just proximal to the anastomosis. Portions of the waveform above the baseline represent flow toward the transducer (antegrade), whereas portions below the baseline represent flow away from the transducer (retrograde). Note the slow, bidirectional ("to-and-fro") flow, which implies sequential perfusion of the graft from different circulations.

View larger version (57K): [in a new window]   FIG 3. Color and pulsed Doppler sonographic image of the saphenous vein graft (arrow) proximal to anastomosis with the posterior cerebral artery. The shunt is patent with low velocity flow. In comparison with figure 2, simultaneous bidirectional flow with high resistance can be seen. Note portions of the waveform above and below the baseline at nearly identical times. This is consistent with a shunt simultaneously being perfused from both the external and internal carotid artery circulations.

View larger version (255K): [in a new window]   FIG 4. Postoperative sagittal view MR image of the brain (top), obtained 14 months after the second EC-IC bypass procedure was performed, reveals near-complete resolution of the aneurysm (arrow). MR angiogram (bottom) shows filling of the superior cerebellar artery (arrowhead) through an anastomosis (small arrow) with a patent saphenous vein graft (large arrow). No blood flow was detected in the aneurysm