An endovascular assisted, nonocclusive cerebral bypass: a technical feasibility study in a rabbit model

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  • 1 Department of Neurosurgery, Kantonsspital Aarau;
  • 2 Department of Biomedical Research, Cerebrovascular Research Group, University of Bern;
  • 3 Department of Biomedical Research, Faculty of Medicine, University of Bern; and
  • 4 Division of Neuroradiology, Kantonsspital Aarau, Switzerland
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OBJECTIVE

Temporary parent vessel occlusion performed to establish a high-flow interpositional bypass carries the risk of infarcts. The authors investigated the feasibility of a novel technique to establish a high-flow bypass without temporary parent vessel occlusion in order to lower the risk of ischemic complications.

METHODS

In 10 New Zealand white rabbits, a carotid artery side-to-end anastomosis was performed under parent artery patency with a novel endovascular balloon device. Intraoperative angiography, postoperative neurological assessments, and postoperative MRI/MRA were performed to evaluate the feasibility and safety of the novel technique.

RESULTS

A patent anastomosis was established in 10 of 10 animals; 3 procedure-related complications occurred. No postoperative focal neurological deficits were observed. The MRI/MRA findings include no infarcts and bypass patency in 50% of the animals.

CONCLUSIONS

The authors demonstrated the feasibility of an endovascular assisted, nonocclusive high-flow bypass. Future refinement of the device and technique in an animal model is necessary to lower the complication rate and increase patency rates.

ABBREVIATIONS CA = carotid artery; CCA = common carotid artery; DSA = digital subtraction angiography; DWI = diffusion-weighted imaging; ENO = endovascular assisted nonocclusive; FA = femoral artery; ICA = internal carotid artery; MCA = middle cerebral artery; PCA = posterior cerebral artery; TOF-A = time-of-flight angiography.

Supplementary Materials

    • Appendix 1 (PDF 409 KB)

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Contributor Notes

Correspondence Alexander Spiessberger: c/o Neuro Research Office, Kantonsspital Aarau, Switzerland. aspiessberger@gmx.ch; neurosurgery@ksa.ch.

INCLUDE WHEN CITING Published online June 5, 2020; DOI: 10.3171/2020.3.JNS20334.

A.S. and F.S. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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