The evolution of cerebral revascularization surgery

Hayden, Melanie; Lee, Marco; Guzman, Raphael

doi:10.3171/2009.3.focus0931

Cited by 33 publications

(36 citation statements)

References 67 publications

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“…In 1980s, STA-MCA bypass fell from favor after an international randomized trial failed to demonstrate any benefit of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke [7]. In the last two decades, the modern technological advancements such as LDF [4, 5, 8], infrared camera thermography [8], and quantitative MRA [9] for hemodynamic measurement have allowed us to reappraise the effect of STA-MCA bypasses on cerebrovascular disease [10, 11]. There is increasing evidence indicated that STA-MCA bypasses not only improve neurological function but also prevent stroke recurrence in subgroup patients of cerebrovascular disease [12-18].…”

Section: Discussionmentioning

confidence: 99%

Effect of Adventitial Dissection of Superficial Temporal Artery on the Outcome of Superficial Temporal Artery-Middle Cerebral Artery Bypass in Moyamoya Disease

Huang

et al. 2017

Aging and disease

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Superficial temporal artery-middle cerebral artery (STA-MCA) has been used for the treatment of occlusive cerebrovascular disease including moyamoya disease. The effect of STA-MCA bypass depends not only on the patency of anastomosis, but also on integrity and functional capacity of the donor artery. In the present prospective study, we investigated the effect of extensive stripping STA adventitia and fasciae on hemodynamic function in STA-MCA bypass of moyamoya disease patients. Twenty patients (n=8 in control group, n=12 in stripping group) of moyamoya disease were subjected to STA-MCA end-to-side direct anastomosis. Perfusion unit (PU) values of the cortex were measured and recorded using a Laser Doppler flowmetry (LDF) for 5 days. Computed tomography perfusion was performed to determine blood flow before and after bypass. No patient experienced significant neurologic deficits associated with neurosurgical complications. LDF demonstrated that adventitial stripping group had higher cerebral blood flow increase than control group. The adventitia stripping group tends to have higher rate of increased cerebral perfusion after bypass than non-stripping group. Furthermore, the ultrasound examination at 3 days after bypass demonstrated that the adventitial stripping group has a tendency of bigger STA and higher peak systolic velocity than control group. Our result suggests that stripping adventitia of STA improves hemodynamics of STA-MCA bypass in moyamoya disease.

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Section: Discussionmentioning

confidence: 99%

Effect of Adventitial Dissection of Superficial Temporal Artery on the Outcome of Superficial Temporal Artery-Middle Cerebral Artery Bypass in Moyamoya Disease

Huang

et al. 2017

Aging and disease

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“…The blood flow of a high-flow bypass is usually more than 50 ml/min. Bypass with RA graft can normally attain blood flow of 50-150 ml/min [11,12]. The greatest disadvantage is the risk of arterial spasm after the artery is harvested which we avoid with the use of a balloon catheter.…”

Section: Choice Of Donor and Graft Vesselsmentioning

confidence: 98%

Management of complex intracranial aneurysms with bypass surgery: a technique application and experience in 93 patients

et al. 2014

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Despite advances in microsurgery and the development of new endovascular techniques, the treatment of complex intracranial aneurysms remains a daunting challenge for neurosurgeons. In the present study, we retrospectively reviewed our experience of bypass surgery in the treatment of 93 cases of complex intracranial aneurysms. A series of 93 consecutive cases of complex intracranial aneurysms were treated with bypass surgery between April 2004 and July 2013. Radial artery (RA) grafts were used in 58 cases, saphenous vein (SV) grafts in 16 cases, and occipital artery (OA) grafts in 6 cases, while the remaining 13 cases were managed with superficial temporal artery (STA) grafts. In this series, the aneurysms were excised after trapping in 32 cases with mass effect and neural compression. Proximal occlusion of the parent artery was performed in 22 cases of fusiform or giant dissecting aneurysms with subsequent retrograde flow to avoid compromise of the perforators nearby. Trapping was performed after bypass surgery in the remaining 39 cases. Postoperative angiographies were performed in 91 patients and patency of the bypass graft and obliteration of the aneurysms were confirmed in 89 patients. Patency of the bypass could not be confirmed in the remaining two patients, of which one presented with cerebral infarction due to graft occlusion, and the other remained asymptomatic. Within 1 month after surgery, 88 patients had good outcome, four patients needed assistance for daily living, and one death occurred due to brainstem infarction. In 77 patients with a mean follow-up of 3.0 years, 72 patients had good outcome, 4 patients needed assistance for daily living, and 1 death occurred unrelated to surgery. Complex intracranial aneurysms present unique therapeutic challenges that require thorough surgical planning, individualized treatment strategies, and refined neurovascular techniques for successful outcome. Proper use of bypass surgery is imperative in preserving the parent artery and its major perforators. The internal maxillary artery, used as a donor in a bypass, is an effective method due to its shorter distance from the recipient vessels and relatively large diameter with resulting higher flow rate.

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“…1 He was awarded the Nobel Prize in Physiology and Medicine in 1912 for his work in this field and organ transplantation 2. In 1902, he performed the first arterial end to end anastomosis 1.…”

Section: Cerebral Revascularization: the Early Yearsmentioning

confidence: 99%

Cerebral revascularization for ischemic disease in the 21st century

Bambakidis

Chowdhry

2010

J NeuroIntervent Surg

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Shortly after the first extracranial to intracranial (EC-IC) carotid artery bypass was performed by Yasargil in 1967 for internal carotid artery occlusion, cerebral revascularization became widely accepted in the neurosurgical field, and the procedures became increasingly used as practitioners began to master the technical aspects of the surgery. The procedures were performed for intracranial arterial stenosis and occlusion and used as an adjunct in the treatment of large aneurysms and skull base tumors. The results of the EC-IC bypass group trial in 1985 were surprising to many and sobering to all; EC-IC bypass for stenosis or occlusion of the high internal carotid artery or middle cerebral artery did not decrease the risk of subsequent stroke compared with medical management. Rather, the incidence of stroke increased, and the events were noted to occur sooner than with medical therapy alone. Despite the known limitations of this landmark study, the number of EC-IC bypass procedures fell precipitously over the ensuing decades. Despite this significant setback, cerebral revascularization is not obsolete. This article revisits the sequence of events leading to the rise of revascularization surgery and recaps the impact of the EC-IC bypass trial. The limitations of the trial are discussed, as are current studies evaluating the efficacy of cerebrovascular bypass procedures for symptomatic carotid occlusive disease. The authors review the accepted indications for bypass surgery in the early 21st century.

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The evolution of cerebral revascularization surgery

Cited by 33 publications

References 67 publications

Effect of Adventitial Dissection of Superficial Temporal Artery on the Outcome of Superficial Temporal Artery-Middle Cerebral Artery Bypass in Moyamoya Disease

Effect of Adventitial Dissection of Superficial Temporal Artery on the Outcome of Superficial Temporal Artery-Middle Cerebral Artery Bypass in Moyamoya Disease

Management of complex intracranial aneurysms with bypass surgery: a technique application and experience in 93 patients

Cerebral revascularization for ischemic disease in the 21st century

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