Artikel
C-Port FlexA-assisted automated anastomosis for high-flow extracranial-intracranial bypass surgery in patients with symptomatic carotid artery occlusion: a clinical feasibility study
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Autoren
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D. Hänggi
- Neurochirugische Klinik, Heinrich-Heine-Universität Düsseldorf
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M. Reinert
- Neurochirurgische Klinik, Inselspital Bern, Universität Bern, Schweiz
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H.-J. Steiger
- Neurochirugische Klinik, Heinrich-Heine-Universität Düsseldorf
| Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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Objective: Preliminary experience with the C-Port System (Cardica, Inc, California, USA) to enable rapid automated anastomosis has been reported in coronary artery bypass surgery. The goal of the current study was to define the feasibility and safety of this method for high-flow extracranial-intracranial (EC-IC) bypass surgery in a clinical series.
Methods: In a prospective study design patients with symptomatic carotid artery occlusion were selected for C-Port assisted high-flow EC-IC bypass surgery if they meet the following criteria: (1) Transient or moderate permanent symptoms of focal ischemia; (2) carotid artery occlusion; (3) haemodynamic instability; (4) obtained informed consent. Bypasses were done using a radial artery graft that was proximally anastomosed to the superficial temporal artery trunk, the cervical external or common carotid artery. All distal cerebral anastomoses were performed on M2 branches using the C-Port FlexA system.
Results: Within 6 months, 10 patients were enrolled in the study. The distal automated anastomosis could be accomplished in all patients; the median temporary occlusion time was 16.6 ± 3.4 minutes. Intraoperative digital subtraction angiogram (DSA) confirmed good bypass function in 9 patients, in one the anastomosis was classified as fair. There was one major perioperative complication, which consisted of the creation of a pseudo aneurysm due to a hardware problem. In all but one the bypass was patent demonstrated with DSA after 7 days, furthermore one patient developed a late occlusion due to vasospasm after a sylvian haemorrhage. Transient asymptomatic extracranial spasm of the donor artery and the radial artery graft was evident in one case as shown by the follow-up DSA 1 week postoperatively. Two patients developed a limited zone of infarction on computerized tomography (CT) in the follow-up course.
Conclusions: C-PORT flexA-assisted high-flow EC-IC bypass surgery in patients with symptomatic carotid artery occlusion is a technically feasible procedure. The system needs further modification to achieve a faster and safer anastomosis for a conclusive comparison with standard and laser assisted methods for high-flow bypass surgery.
