High-flow excimer laser-assisted extra-intracranial and intra-intracranial bypass

High-flow revascularization of the brain is hampered by the fact that temporary occlusion of a major brain artery, necessary to make the distal end-to-side anastomosis, may result in brain ischemia. The Excimer laser-assisted nonocclusive anastomosis technique circumvents this problem. After connecting donor and recipient vessels, an Excimer laser catheter, introduced by way of an artificial side branch, creates a hole at the anastomosis site. When the catheter is withdrawn, a round full-thickness portion of the recipient artery is removed. When the artificial side branch is occluded with a hemoclip the anastomosis is completed. The recipient vessel stays open during the procedure. In 90 patients a high-flow bypass was made. In 90% several types of extra-intracranial bypasses were created, and in 10% several types of intra-intracranial bypasses were created. Flow recordings by way of an ultrasound device intraoperatively and with a magnetic resonance (MR) flow program postoperatively show the bypasses to have a real “high flow” character. Complications related to this high-flow bypass procedure and ways to prevent them are presented.