Clinical factors influencing the development of extracranial-intracranial bypass graft for steno-occlusive cerebrovascular disease

Nomura, Shunsuke; Yamaguchi, Koji; Ishikawa, Tatsuya; Kawashima, Akitsugu; Okada, Yoshikazu; Kawamata, Takakazu

doi:10.3171/2018.11.focus18500

Cited by 6 publications

(6 citation statements)

References 11 publications

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“…The use of antithrombotic agents was described; however, cilostazol use was not identified in any case. A study 14 attempted to evaluate bypass patency for EC-IC bypass using STA diameter. However, in previous quantitative evaluations 22 using 4D flow MRI, BFV of the bypassed was weakly correlated with the diameter.…”

Section: Discussionmentioning

confidence: 99%

“…The basic surgical strategy was STA-MCA double anastomosis. 4,11,14,15 To prevent postoperative hyperperfusion and cerebral hemorrhage, we adopted a policy of elective double bypass, as follows. 11 After completing one anastomosis with the larger STA, the other branch of the STA was connected to the arterial line, and preanastomotic MCA cerebral surface pressure was monitored before commencing the second bypass.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…Several studies 4,8,14,25,32 on atherosclerotic lesions have reported on the significance of double bypass. A previous singleinstitution study 25 (mean follow-up time was 4.1 ± 3.5 years) reported that the patency rate was significantly higher for single bypass than for double bypass (P = .005).…”

Section: Double Bypassmentioning

confidence: 99%

“…9,12 To promote the effectiveness of bypass surgery for preventing stroke compared with antithrombotic therapy alone, efforts to maintain long-term patency are critical. 10,[13][14][15] However, because of the small number of patients who have undergone EC-IC bypass for ICA occlusive disease, excluding moyamoya disease, there are few studies 10,[13][14][15] on the factors that influence the long-term patency of EC-IC bypass. Moreover, the studies assessing the patency of bypass vessels are limited to observations using magnetic resonance angiography (MRA) or computed tomographic angiography and do not quantitatively determine the degree of occlusion.…”

mentioning

confidence: 99%

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Factors Influencing Long-Term Blood Flow in Extracranial-to-Intracranial Bypass for Symptomatic Internal Carotid Artery Occlusive Disease: A Quantitative Study

et al. 2022

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BACKGROUND: Maintaining the patency of extracranial-to-intracranial (EC-IC) bypass is critical for long-term stroke prevention. However, reports on the factors influencing longterm bypass patency and quantitative assessments of bypass patency are limited. OBJECTIVE: To quantitatively evaluate blood flow in EC-IC bypass using four-dimensional (4D) flow magnetic resonance imaging (MRI) and investigate factors influencing the longterm patency of EC-IC bypass. METHODS: Thirty-six adult Japanese patients who underwent EC-IC bypass for symptomatic internal carotid or middle cerebral artery occlusive disease were included. We examined the relationships between decreased superficial temporal artery (STA) blood flow volume and perioperative complications, long-term ischemic complications, patient background, and postoperative antithrombotic medications in patients for whom STA flow could be quantitatively assessed for at least 5 months using 4D flow MRI. RESULTS: The mean follow-up time was 54.7 ± 6.1 months. One patient presented with a stroke during the acute postoperative period that affected postoperative outcomes. No recurrent strokes were recorded during long-term follow-up. Two patients died of malignant disease. Seven cases of reduced flow occurred in the STA, which were correlated with single bypass (P = .0294) and nonuse of cilostazol (P = .0294). STA occlusion was observed in 1 patient during the follow-up period. Hypertension, age, smoking, dyslipidemia, and diabetes mellitus were not correlated with reduced blood flow in the STA. CONCLUSION: Double anastomoses and cilostazol resulted in long-term STA blood flow preservation. No recurrence of cerebral infarction was noted in either STA hypoperfusion or occlusion cases.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

Section: Double Bypassmentioning

confidence: 99%

mentioning

confidence: 99%

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Factors Influencing Long-Term Blood Flow in Extracranial-to-Intracranial Bypass for Symptomatic Internal Carotid Artery Occlusive Disease: A Quantitative Study

et al. 2022

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“…3 In a series of 430 bypass procedures, 12 bypass occlusions (2.8%) occurred within 1 week of revascularization, 23 and in a series of 47 patients who had undergone EC-IC bypass, diabetes and hyperlipidemia were found to be risk factors for poor development of the bypass graft. 24 Wound complications are rare in craniotomies because of the redundancy of the rich vascular network to the scalp. However, the EC-IC bypass procedure requires the harvest and diversion of a major scalp vessel, commonly the superior temporal artery (STA), to the brain surface.…”

Section: Readmission and Postoperative Complicationsmentioning

confidence: 99%

Readmission following extracranial-intracranial bypass surgery in the United States: nationwide rates, causes, risk factors, and volume-driven outcomes

Rumalla

Srinivasan

Gaddis

et al. 2021

Journal of Neurosurgery

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OBJECTIVEExtracranial-intracranial (EC-IC) bypass surgery remains an important treatment option for patients with moyamoya disease (MMD), intracranial arteriosclerotic disease (ICAD) with symptomatic stenosis despite the best medical management, and complex aneurysms. The therapeutic benefit of cerebral bypass surgery depends on optimal patient selection and the minimization of periprocedural complications. The nationwide burden of readmissions and associated complications following EC-IC bypass surgery has not been previously described. Therefore, the authors sought to analyze a nationwide database to describe the national rates, causes, risk factors, complications, and morbidity associated with readmission following EC-IC bypass surgery for MMD, ICAD, and aneurysms.METHODSThe Nationwide Readmissions Database (NRD) was queried for the years 2010–2014 to identify patients who had undergone EC-IC bypass for MMD, medically failed symptomatic ICAD, or unruptured aneurysms. Predictor variables included demographics, preexisting comorbidities, indication for surgery, and hospital bypass case volume. A high-volume center (HVC) was defined as one that performed 10 or more cases/year. Outcome variables included perioperative stroke, discharge disposition, length of stay, total hospital costs, and readmission (30 days, 90 days). Multivariable analysis was used to identify predictors of readmission and to study the effect of treatment at HVCs on quality outcomes.RESULTSIn total, 2500 patients with a mean age of 41 years were treated with EC-IC bypass surgery for MMD (63.1%), ICAD (24.5%), or unruptured aneurysms (12.4%). The 30- and 90-day readmission rates were 7.5% and 14.0%, respectively. Causes of readmission included new stroke (2.5%), wound complications (2.5%), graft failure (1.5%), and other infection (1.3%). In the multivariable analysis, risk factors for readmission included Medicaid/self-pay (OR 1.6, 95% CI 1.1–2.4, vs private insurance), comorbidity score (OR 1.2, 95% CI 1.1–1.4, per additional comorbidity), and treatment at a non-HVC (OR 1.9, 95% CI 1.1–3.0). Treatment at an HVC (17% of patients) was associated with significantly lower rates of nonroutine discharge dispositions (13.4% vs 26.7%, p = 0.004), ischemic stroke within 90 days (0.8% vs 2.9%, p = 0.03), 30-day readmission (3.9% vs 8.2%, p = 0.03), and 90-day readmission (8.6% vs 15.2%, p = 0.01). These findings were confirmed in a multivariable analysis. The authors estimate that centralization to HVCs may result in 333 fewer nonroutine discharges (50% reduction), 12,000 fewer hospital days (44% reduction), 165 fewer readmissions (43%), and a cost savings of $15.3 million (11% reduction).CONCLUSIONSReadmission rates for patients after EC-IC bypass are comparable with those after other common cranial procedures and are primarily driven by preexisting comorbidities, socioeconomic status, and treatment at low-volume centers. Periprocedural complications, including stroke, graft failure, and wound complications, occurred at the expected rates, consistent with those in prior clinical series. The centralization of care may significantly reduce perioperative complications, readmissions, and hospital resource utilization.

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Surgical therapy for chronic internal carotid artery occlusion: a systematic review and meta-analysis

Cao

Tian

et al. 2021

Updates Surg

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Clinical factors influencing the development of extracranial-intracranial bypass graft for steno-occlusive cerebrovascular disease

Cited by 6 publications

References 11 publications

Factors Influencing Long-Term Blood Flow in Extracranial-to-Intracranial Bypass for Symptomatic Internal Carotid Artery Occlusive Disease: A Quantitative Study

Factors Influencing Long-Term Blood Flow in Extracranial-to-Intracranial Bypass for Symptomatic Internal Carotid Artery Occlusive Disease: A Quantitative Study

Readmission following extracranial-intracranial bypass surgery in the United States: nationwide rates, causes, risk factors, and volume-driven outcomes

Surgical therapy for chronic internal carotid artery occlusion: a systematic review and meta-analysis

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