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Clip-Grafts for Aneurysm and Small Vessel Surgery

Part 1: Repair of Segmental Defects with Clip-Grafts; Laboratory Studies and Clinical Correlations

Thoralf M. Sundt Jr. and John D. Nofzinger

's Preop. Grade Location of Aneurysm Graft Patency (by Postop. Arteriogram) Postop. Results Remarks 1 68 3 carotid posterior communicating yes death died of pulmonary embolism 14 days after surgery; had monoparesis pre- and postoperatively 2 65 4 carotid posterior communicating yes death decerebrate before surgery; died 5 wks postoperatively from myocardial infarction 3 48 2 carotid posterior communicating yes death died of damage from subdural hematoma considered result of error in surgical technique

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Clip-Grafts for Aneurysm and Small Vessel Surgery

Part 3: Clinical Experience in Intracranial Internal Carotid Artery Aneurysms

Thoralf M. Sundt Jr. and Francis Murphey

result, one good result, and three deaths. The cause of death in two patients was a myocardial infarction, and in the third, progressive and severe “vasospasm.” In the two patients who suffered myocardial infarction, it was felt the underlying cause for their lingering illness and ultimate death was related to “vasospasm.” The mortality in this group was therefore 60%. Grade V Candidates No grade V candidates were operated on. Graft Patency The radiopaque column of Hypaque can be visualized on postoperative arteriograms through the clip

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Robert M. Crowell and Yngve Olsson

was present in three of eight controls, two of eight animals with patent grafts, and four of 11 animals with occluded grafts. Discussion The data show that in the dog STA-MCA branch anastomosis done within 2 hours after MCA root occlusion leads to significant decreases in functional deficit and structural damage. The beneficial result appears to be independent of long-term graft patency. With practice and careful attention to details of microsurgical technique, STA-MCA branch anastomosis in the dog can be accomplished with acceptable patency rates (63

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Otmar Gratzl, Peter Schmiedek, Robert Spetzler, Harald Steinhoff and Frank Marguth

first month postoperatively, one from brain edema, the other from complicating renal failure. Evaluation of the extra-intracranial anastomosis revealed graft patency in each of these fatal cases. The most recent follow-up (October, 1974) includes observation periods from 6 to 54 months with an average of 19.2 months in 59 patients postoperatively. We did not include one patient of the completed stroke group who died 18 months postoperatively from a glioblastoma of the contralateral (non-operated) hemisphere. When we compared the neurological condition of the

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Thoralf M. Sundt Jr. and David G. Piepgras

but considered high risks for stroke * Case No. Age, Sex Symptom Complex Trial AC Preop Lesion in Intracranial Vertebral Artery Graft Patency Operative Complications Clinical Result † Residual Deficit Left Right 2 55, TIA, POCI yes stenosis stenosis yes none exc none M 5 65, TIA, POCI no congenital occlusion yes small cerebellar exc ataxia M variant ‡ infarct 6 61, TIA, infarct yes occlusion

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Superficial temporal-middle cerebral artery bypass

A detailed analysis of multiple pre- and postoperative angiograms in 40 consecutive patients

Richard E. Latchaw, James I. Ausman and Myoung C. Lee

provided by the bypass. It is well known that radioisotopic cerebral blood flow values suffer from considerable fluctuation, as evidenced by the large discrepancies in testing and retesting the same normal subject; differences of at least 14% must be present to be significant. 4 Evaluation of other bypass circuits has been made angiographically; for example, a combination of graft patency and extent of revascularization as determined on an angiogram has been related to the postsurgical clinical state of coronary artery bypass patients. 1 In a similar fashion, we have

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demonstrate expertise in neurosurgery, neurology, and neuroradiology before consideration for participation. Neurosurgical criteria for participation included the completion of at least 10 EC-IC bypass procedures, with a minimum 80% graft patency rate and 90% surgical survival rate. At present, over 750 patients have been entered into the study. It is our aim to enter at least 20 patients per center, with a total entry somewhat in excess of 1000 patients. At the current rate of entry, we expect to achieve this goal by the summer of 1981. Patients will be followed for an

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Robert F. Spetzler, Robert S. Rhodes, Richard A. Roski and Matt J. Likavec

patients with aorto-coronary artery vein grafts 2 weeks, 1 year, and 3 years after operation. J Thorac Cardiovasc Surg 67 : 1 – 6 , 1974 Grondin CM, Lésperance J, Bourassa MG, et al: Serial angiographic evaluation in 60 consecutive patients with aorto-coronary artery vein grafts 2 weeks, 1 year, and 3 years after operation. J Thorac Cardiovasc Surg 67: 1–6, 1974 9. Lawrie GM , Lie JT , Morris GC Jr , et al : Vein graft patency and intimal proliferation after aortocoronary bypass: early and long-term angiopathologic

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Thoralf M. Sundt Jr., David G. Piepgras, O. Wayne Houser and J. Keith Campbell

hrs from surgery) 3  late 2 subdural hygroma (requiring shunting) 4 homonymous field defect from transient occlusion of posterior cerebral artery 1 venous infarct, temporal lobe 1 minor strokes following graft occlusion 2 major strokes following graft occlusion 2 death following graft occlusion 1 Graft Patency Graft patency can easily be determined in these cases by merely palpating the pulse of the saphenous vein. However, all patients with a patent graft have undergone postoperative

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Posterior circulation revascularization

Superficial temporal artery to superior cerebellar artery anastomosis

James I. Ausman, Fernando G. Diaz, R. A. de los Reyes, Hooshang Pak, Suresh Patel, Bharat Mehta and Roushdy Boulos

Graft Patency Operative Complications 1 61, M yes no occlusion yes TLS 2 63, M no yes occlusion yes TLS, SDH 3 64, M no yes stenosis yes TLS 4 67, F no yes stenosis yes TLS 5 60, M yes yes stenosis yes none 6 42, F no no stenosis yes none 7 58, M no no stenosis yes none 8 67, F yes yes stenosis no BA thrombosis * BA = basilar artery; TLS = temporal lobe swelling; and SDH = subdural hematoma. TABLE