Seungwon Yoon1, Jan-Karl Burkhardt2, Michael T Lawton1. 1. 1Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona; and. 2. 2Department of Neurological Surgery, University of California, San Francisco, California.
Abstract
OBJECTIVE: Large cohort analysis concerning intracerebral bypass patency in patients with long-term follow-up (FU) results is rarely reported in the literature. The authors analyzed the long-term patency of extracranial-to-intracranial (EC-IC) and intracranial-to-intracranial (IC-IC) bypass procedures. METHODS: All intracranial bypass procedures performed between 1997 and 2017 by a single surgeon were screened. Patients with postoperative imaging (CT angiography, MR angiography, or catheter angiography) were included and grouped into immediate (< 7 days), short-term (7 days-1 year), and long-term (> 1 year) FU groups. Data on patient demographics, bypass type, interposition graft type, bypass indication, and radiological patency were collected and analyzed with univariate and multivariate (adjusted multiple regression) models. RESULTS: In total, 430 consecutive bypass procedures were performed during the study period (FU time [mean ± SD] 0.9 ± 2.2 years, range 0-17 years). Twelve cases were occluded at FU imaging, resulting in an overall cumulative patency rate of 97%. All bypass occlusions occurred within a week of revascularization. All patients in the short-term FU group (n = 76, mean FU time 0.3 ± 0.3 years) and long-term FU group (n = 89, mean FU time 4.1 ± 3.5 years) had patent bypasses at last FU. Patients who presented with aneurysms had a lower rate of patency than those with moyamoya disease or chronic vessel occlusion (p = 0.029). Low-flow bypasses had a significantly higher patency rate than high-flow bypasses (p = 0.033). In addition, bypasses with one anastomosis site compared to two anastomosis sites showed a significantly higher bypass patency (p = 0.005). No differences were seen in the patency rate among different grafts, single versus bilateral, or between EC-IC and IC-IC bypasses. CONCLUSIONS: The overall bypass patency of 97% indicates a high likelihood of success with microsurgical revascularization. Surgical indication (ischemia), low-flow bypass, and number of anastomosis (one site) were associated with higher patency rates. EC-IC and IC-IC bypasses have comparable patency rates, supporting the use of intracranial reconstructive techniques. Bypasses that remain patent 1 week postoperatively and have the opportunity to mature have a high likelihood of remaining patent in the long term. In experienced hands, cerebral revascularization is a durable treatment option with high patency rates.
OBJECTIVE: Large cohort analysis concerning intracerebral bypass patency in patients with long-term follow-up (FU) results is rarely reported in the literature. The authors analyzed the long-term patency of extracranial-to-intracranial (EC-IC) and intracranial-to-intracranial (IC-IC) bypass procedures. METHODS: All intracranial bypass procedures performed between 1997 and 2017 by a single surgeon were screened. Patients with postoperative imaging (CT angiography, MR angiography, or catheter angiography) were included and grouped into immediate (< 7 days), short-term (7 days-1 year), and long-term (> 1 year) FU groups. Data on patient demographics, bypass type, interposition graft type, bypass indication, and radiological patency were collected and analyzed with univariate and multivariate (adjusted multiple regression) models. RESULTS: In total, 430 consecutive bypass procedures were performed during the study period (FU time [mean ± SD] 0.9 ± 2.2 years, range 0-17 years). Twelve cases were occluded at FU imaging, resulting in an overall cumulative patency rate of 97%. All bypass occlusions occurred within a week of revascularization. All patients in the short-term FU group (n = 76, mean FU time 0.3 ± 0.3 years) and long-term FU group (n = 89, mean FU time 4.1 ± 3.5 years) had patent bypasses at last FU. Patients who presented with aneurysms had a lower rate of patency than those with moyamoya disease or chronic vessel occlusion (p = 0.029). Low-flow bypasses had a significantly higher patency rate than high-flow bypasses (p = 0.033). In addition, bypasses with one anastomosis site compared to two anastomosis sites showed a significantly higher bypass patency (p = 0.005). No differences were seen in the patency rate among different grafts, single versus bilateral, or between EC-IC and IC-IC bypasses. CONCLUSIONS: The overall bypass patency of 97% indicates a high likelihood of success with microsurgical revascularization. Surgical indication (ischemia), low-flow bypass, and number of anastomosis (one site) were associated with higher patency rates. EC-IC and IC-IC bypasses have comparable patency rates, supporting the use of intracranial reconstructive techniques. Bypasses that remain patent 1 week postoperatively and have the opportunity to mature have a high likelihood of remaining patent in the long term. In experienced hands, cerebral revascularization is a durable treatment option with high patency rates.
Authors: Claudio Cavallo; Sirin Gandhi; Xiaochun Zhao; Evgenii Belykh; Daniel Valli; Peter Nakaji; Mark C Preul; Michael T Lawton Journal: Front Surg Date: 2019-11-28