Stephen Monteith1, Oded Goren1, Ragu Sampath1, Eric Lehr2, Akshal Patel1, Paul J Choi3, Joe Iwanaga4, Marios Loukas5, R Shane Tubbs6. 1. Swedish Neuroscience Institute, Seattle, Washington, USA. 2. Swedish Hospital, Seattle, Washington, USA. 3. Seattle Science Foundation, Seattle, Washington, USA. Electronic address: paulchoi92@gmail.com. 4. Seattle Science Foundation, Seattle, Washington, USA. 5. Department of Anatomical Sciences, St. George's University, Grenada. 6. Swedish Neuroscience Institute, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, Grenada.
Abstract
BACKGROUND: A few options of extracranial donor vessels exist for use in intracranial vascular bypass procedures. To our knowledge, the use of an internal thoracic artery for cerebral revascularization has not been studied previously. Hence, this cadaveric feasibility study was performed. METHODS: The internal thoracic artery was dissected in 5 adult cadaveric specimens. The proximal diameter, distal diameter, and length of the vessel were measured and recorded. The artery was then transected distally at the seventh intercostal space and transposed cranially, through a pterional craniotomy opening to reach the middle cerebral artery at the skull base. RESULTS: The mean diameter of the internal thoracic artery at its proximal end was 3.5 mm and at its distal end was 2 mm. The average length of the vessel was 31 cm. There was no statistical difference between the measurements recorded from different sides or sexes. In each specimen, an internal thoracic artery was dissected, rotated superiorly, and advanced subcutaneously behind the ear to reach the middle cerebral artery at the skull base without difficulty and remained tensionless at the site of anastomosis. CONCLUSIONS: In this cadaveric study, we demonstrated the suitability of the internal thoracic artery in use as a donor vessel for a single site anastomosis in a high-flow cerebral bypass procedure.
BACKGROUND: A few options of extracranial donor vessels exist for use in intracranial vascular bypass procedures. To our knowledge, the use of an internal thoracic artery for cerebral revascularization has not been studied previously. Hence, this cadaveric feasibility study was performed. METHODS: The internal thoracic artery was dissected in 5 adult cadaveric specimens. The proximal diameter, distal diameter, and length of the vessel were measured and recorded. The artery was then transected distally at the seventh intercostal space and transposed cranially, through a pterional craniotomy opening to reach the middle cerebral artery at the skull base. RESULTS: The mean diameter of the internal thoracic artery at its proximal end was 3.5 mm and at its distal end was 2 mm. The average length of the vessel was 31 cm. There was no statistical difference between the measurements recorded from different sides or sexes. In each specimen, an internal thoracic artery was dissected, rotated superiorly, and advanced subcutaneously behind the ear to reach the middle cerebral artery at the skull base without difficulty and remained tensionless at the site of anastomosis. CONCLUSIONS: In this cadaveric study, we demonstrated the suitability of the internal thoracic artery in use as a donor vessel for a single site anastomosis in a high-flow cerebral bypass procedure.