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  • Cerebral Revascularization in the Endovascular era: Clinical indications, Surgical results and Outcomes at the Barrow Neurological Institute

    Final Number:

    Leonardo Rangel-Castilla MD; M. Yashar S. Kalani MD, PhD; Jonathan Russin MD; Wyatt L. Ramey MD; Justin C. Clark MD; Peter Nakaji MD; Joseph Zabramsky; Robert F. Spetzler MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Because the advances in endovascular techniques, indications for cerebral revascularzation in intracranial vascular pathologies have declined. We sought to defined indications, highlight surgical strategies, analyze clinical results of patients treated with bypass procedures in the endovascular era

    Methods: We retrospectively reviewed all bypass procedures performed from 1/2006 to 3/2013. The database was subdivided in moymoya angiopathy (MMA), intracranial aneurysms (IA), and intracranial occlusion diseases (IOD).

    Results: A total of 225 bypass procedures were performed in 185 patients (mean age 46.2 years (1-80 years)). 135 direct and 90 indirect bypasses. The MMA group consisted of 129 bypasses (87 indirect, 42 direct) in 92 patients. The preoperative GOS was 4.29 and postoperative was 4.616. There were no deaths and 9 perioperative complications. The IA group had 58 patients (mean age 46.3, range (1-78)) with complex aneurysms (giant 18, fusiform 17, multilobulated 13, lood-lister-like 7, pseudoaneurysms 2, mycotic 1). Ten were ruptured, 14 had cranial neuropathy, 3 brainstem compression, 3 strokes, 2 pseudoaneurysms and the rest had headaches. Fourty-six were in the anterior and 12 in the posterior circulation. There were 7 deaths and 6 major complications. The IOD disease group included 38 bypasses in 35 patients. The etiology of the vascular occlusion was atherosclerosis 24, iatrogenic 5, dissection 3, vasculitis 1, and 2 vertebral artery dissection. The preoperative and postoperative GOS were 3.87 and 4.63. There were 4 periprocedural complications. More details of the procedures and patient outcomes will be presented.

    Conclusions: The emergence of new endovascular techniques has revolutionized the treatment of certain intracranial vascular pathologies. However, this series demonstrates the importance of cerebral revascularization in the neurosurgical armamentarium. Moyamoya angiopathy , complex intracranial aneurysms and selected intracranial disease pathologies are the main groups benefited from cerebral revascularization procedures.

    Patient Care: Improve the management and outcome of patients with complex intracranial vascular diseases.

    Learning Objectives: To determined and select candidates for cerebral revascularization procedures Establish the current indications for cerebral revascularization in the endovascular era


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