Endoscopic radial artery harvesting for U-clip high-flow EC-IC bypass: technical report.

Abstract

Bypass and aneurysm trapping constitute a well-known surgical solution for aneurysms that are not suitable for clipping or coiling. New techniques are available that make EC-IC bypass procedures easier, safer and, possibly, less invasive. The nitinol self-closing U-Clip device (Medtronic, Inc., Minneapolis) has been designed to facilitate the interrupted suture technique by eliminating the need for suture management, knot tying, and surgical assistance. We present two consecutive U-clip bypass procedures in which the radial artery graft was harvested endoscopically. This novel bypass technique employs endoscopy to minimise arm injury due to radial artery harvesting and self-closing U-clips to simplify the intracranial micro-anastomosis and reduce the temporary occlusion time. Angiography confirmed bypass patency in all patients. Combined with the innovative use of U-clips, these two examples illustrate how new technologies can simplify EC-IC bypass surgery while yielding a better cosmetic and functional outcome.