Abstract
Extracranial-intracranial (EC-IC) bypass is a revascularization option for complex cerebrovascular disease such as moyamoya in adults and flow replacement prior to planned vessel sacrifice for treatment of complex and fusiform aneurysms that are not amenable to coiling or clipping. Usually in EC-IC bypass, the superficial temporal artery is anastomosed to a middle cerebral artery branch (Fig. 12.1 and 12.2). Alternatively, saphenous vein grafts can be used. EC-IC bypass is performed via a small craniectomy in the temporal region, so as to expose the Sylvian fissure and the right temporal lobe. On follow-up angiography, increase in caliber of the recipient and donor arteries can be observed. On the other hand, basal collateral vessels often regress. Graft patency can be readily assessed via MRA or CTA. Stenosis or occlusion of the bypass typically occurs at or near the anastomosis (Fig. 12.3). Correlation with pre-contrast images is recommended, since hyperacute clot can appear as hyperdense, mimicking graft patency.
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Further Reading
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Ginat, D.T., Romero, J.M. (2012). Imaging of Vascular and Endovascular Surgery. In: Atlas of Postsurgical Neuroradiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-15828-5_12
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