In Vivo Preclinical Quantitative Flow Analysis of Arterial Anastomosis Using a Microvascular Anastomotic Coupler and Clinical Application for Extracranial-to-Intracranial Bypass

Authors

Tyler S. Cole, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Sirin Gandhi, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Joshua S. Catapano, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Vance L. Fredrickson, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Neil Majmundar, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Felipe C. Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Andrew F. Ducruet, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Mark C. Preul, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@barrowneuro.org.Follow

Document Type

Article

Abstract

OBJECTIVE: Although several commercially available sutureless anastomotic techniques are available, they are not routinely used in neurosurgery. We performed an in vivo flow analysis of end-to-end anastomosis using a microvascular coupler device in rats. We report our first clinical use of the microvascular anastomotic coupler. METHODS: Bilateral rat common carotid arteries (CCAs) were exposed, and a microvascular coupler was used to perform 8 anastomoses. A microflow probe provided quantitative measurement of blood-flow volume. Flow augmentation was assessed with end-to-side anastomoses connecting the distal CCA to the jugular vein (JV). A patient with chronic dominant hemisphere atherosclerotic ischemic disease and progressive symptoms refractory to medical management underwent end-to-end cerebral artery bypass using the microvascular coupler. RESULTS: Mean preanastomosis flow in the rat CCA was 3.95 ± 0.45 mL/min; this flow was maintained at 3.99 ± 0.24 mL/min on final measurements 54-96 minutes postanastomosis. Total occlusion time for each rat CCA was 12-19 minutes. After end-to-side anastomosis, with proximal and distal JV patent, CCA flow increased 477% to 22.8 ± 3.70 mL/min (P = 0.04, proximal; P = 0.01, distal). After in vivo testing, we successfully used the coupler clinically in a superficial temporal artery-to-middle cerebral artery bypass for dominant hemisphere flow augmentation. CONCLUSIONS: In vivo quantitative flow analysis demonstrated no flow difference between an unaltered artery and artery with end-to-end anastomosis using a microvascular coupler in rats. A 1-mm coupled anastomosis achieved a 4-fold flow increase with low-resistance venous outflow in rats, simulating increased arterial demand. The coupler was successfully used for extracranial-to-intracranial bypass in a patient.

Medical Subject Headings

Anastomosis, Surgical (methods); Animals; Humans; Microsurgery; Middle Cerebral Artery (surgery); Rats; Temporal Arteries (surgery); Vascular Surgical Procedures

Publication Date

5-1-2022

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

161

First Page

e126

Last Page

e133

PubMed ID

35093577

Digital Object Identifier (DOI)

10.1016/j.wneu.2022.01.082

Recommended Citation

Cole, Tyler S.; Gandhi, Sirin; Catapano, Joshua S.; Fredrickson, Vance L.; Majmundar, Neil; Albuquerque, Felipe C.; Ducruet, Andrew F.; Preul, Mark C.; and Lawton, Michael T., "In Vivo Preclinical Quantitative Flow Analysis of Arterial Anastomosis Using a Microvascular Anastomotic Coupler and Clinical Application for Extracranial-to-Intracranial Bypass" (2022). Neurosurgery. 1579.
https://scholar.barrowneuro.org/neurosurgery/1579