Endovascular Management of Cerebral Bypass Graft Problems: An Analysis of Technique and Results

D. Ramanathan; B. Ghodke; L.J. Kim; D. Hallam; M. Herbes-Rocha; L.N. Sekhar

doi:10.3174/ajnr.A2565

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Fig 1.
A, Postoperative angiogram (IADSA), lateral view right ICA injection, shows the IC-IC bypass from the MCA to the PCA. B, Angiogram (IADSA), right ICA anteroposterior view, with the catheter showing poor graft filling before the angioplasty procedure. C, Angiogram shows the balloon catheter (arrow) positioned in the graft across the segment of narrowing in the proximal graft. D, Post-PTA IADSA showing much better graft flow (arrow). Distal segments of the graft show narrowing.
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Fig 2.
A, Angiogram (IADSA), ICA anteroposterior view, status postclipping of a giant MCA aneurysm shows the stenotic MCA branches—superior and inferior. B, Angiographic 3D reconstruction shows the RAG bypass on the left side from the ECA to the MCA M2, immediately postsurgery. C, Angiogram (IADSA), ICA injection, anteroposterior view, 8 months postoperatively, shows the poor flow in the graft with a stenosis in the proximal fourth of the graft (arrow). D, Angiogram, lateral view left common carotid injection, shows the HyperGlide balloon catheter (arrow) with the Envoy catheter in the graft vessel. E, Angiogram (IADSA), ICA injection, anteroposterior oblique view, immediately after angioplasty and stent placement (arrow), shows good filling of the bypass graft. F, Angiogram (IADSA), common carotid anteroposterior oblique view 3 months after angioplasty and stent placement, with the arrow showing the stent in place and a much-improved flow.