Surgical revascularization continues to play an important role in the management of complex intracranial aneurysms and ischemic cerebrovascular disease. Graft spasm is a common complication of bypass procedures and can result in ischemia or graft thrombosis. The authors here report on the first clinical use of botulinum toxin to prevent graft spasm following extracranial-intracranial (EC-IC) bypass. This technique was used in 3 EC-IC bypass surgeries, 2 for symptomatic carotid artery occlusions and 1 for a ruptured basilar tip aneurysm. In all 3 cases, the harvested graft was treated ex vivo with botulinum toxin before the anastomosis was performed. Post-bypass vascular imaging demonstrated patency and the absence of spasm in all grafts. Histopathological analyses of treated vessels did not show any immediate endothelial or vessel wall damage. Postoperative angiograms were without graft spasm in all cases. Botulinum toxin may be a reasonable option for preventing graft spasm and maintaining patency in cerebral revascularization procedures.
ABBREVIATIONSBTX = botulinum toxin; DLCFA = descending branch of the lateral circumflex femoral artery; EC-IC = extracranial-intracranial; ICA = internal carotid artery; MCA = middle cerebral artery; RA = radial artery; SAH = subarachnoid hemorrhage; STA = superficial temporal artery.
BaikoussisNGPapakonstantinouNAApostolakisE: Radial artery as graft for coronary artery bypass surgery: Advantages and disadvantages for its usage focused on structural and biological characteristics. J Cardiol63:321–3282014
El TecleNEZammarSGHamadeYJAhmadiehTYEAounRJNNanneyAD: Use of a harvested radial artery graft with preservation of the vena comitantes to reduce spasm risk and improve graft patency for extracranial to intracranial bypass: technical note. Clin Neurol Neurosurg142:65–712016
IshikawaHMitsuiYYoshitomiTMashimoKAokiSMukunoK: Presynaptic effects of botulinum toxin type A on the neuronally evoked response of albino and pigmented rabbit iris sphincter and dilator muscles. Jpn J Ophthalmol44:106–1092000
LowSWTeoKLwinSYeoLLPaliwalPRAhmadA: Improvement in cerebral hemodynamic parameters and outcomes after superficial temporal artery-middle cerebral artery bypass in patients with severe stenoocclusive disease of the intracranial internal carotid or middle cerebral arteries. J Neurosurg123:662–6692015
MatsukawaHTanikawaRKamiyamaHTsuboiTNodaKOtaN: Risk factors for neurological worsening and symptomatic watershed infarction in internal carotid artery aneurysm treated by extracranial-intracranial bypass using radial artery graft. J Neurosurg125:239–2462016
NodaMYasuda-FukazawaCMoriishiKKatoTOkudaTKurokawaK: Involvement of rho in GTP gamma S-induced enhancement of phosphorylation of 20 kDa myosin light chain in vascular smooth muscle cells: inhibition of phosphatase activity. FEBS Lett367:246–2501995
SiaSFQianYZhangYMorganMK: Mean arterial pressure required for maintaining patency of extracranial-to-intracranial bypass grafts: an investigation with computational hemodynamic models-case series. Neurosurgery71:826–8312012
TarabalOCalderóJRiberaJSorribasALópezRMolgóJ: Regulation of motoneuronal calcitonin gene-related peptide (CGRP) during axonal growth and neuromuscular synaptic plasticity induced by botulinum toxin in rats. Eur J Neurosci8:829–8361996