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extracranial artery surgery

Nupoor Narula, Daniella Kadian-Dodov, Jeffrey W Olin
Fibromuscular dyplasia (FMD) is an under-recognized non-atherosclerotic, non-inflammatory arteriopathy that occurs most commonly in middle-aged women, but may affect individuals of all age groups. FMD may result in stenosis, aneurysm, dissection, occlusion, or arterial tortuosity. Recently published data demonstrated a genetic association of FMD with a variant in the phosphatase and actin regulator 1 gene (PHACTR1), substantiating that the pathogenesis of this condition has genetic contribution. The renal and extracranial carotid and vertebral arteries are most often involved, although any arterial bed may be affected...
March 10, 2018: Progress in Cardiovascular Diseases
Tomohiro Tsunekawa, Motoshi Sawada, Takayoshi Kato, Yusuke Motoji, Tatsuomi Kinoshita, Akihiro Hirakawa, Yasuhide Okawa, Shinji TomitaMD
OBJECTIVES: Intracranial cerebral atherosclerosis is a significant predictor of stroke after coronary artery bypass grafting (CABG). However, there is limited information on intracranial occlusive lesions in patients undergoing CABG. The purpose of the study was to elucidate the precise prevalence and distribution of occlusive lesions of the extracranial and intracranial arteries in patients undergoing CABG. METHODS: Between 2009 and 2016, 205 patients underwent preoperative magnetic resonance angiography (MRA) and elective CABG...
March 5, 2018: Seminars in Thoracic and Cardiovascular Surgery
Kenichi Sato, Hidenori Endo, Miki Fujimura, Toshiki Endo, Yasushi Matsumoto, Hiroaki Shimizu, Teiji Tominaga
OBJECTIVE: Although most intracranial aneurysms can be treated with microsurgery or endovascular procedure alone, a subset of aneurysms may require a combined approach. The purpose of this study was to assess the efficacy of endovascular interventions combined with bypass surgery for the treatment of complex intracranial aneurysms. METHODS: We retrospectively reviewed medical records from a prospectively maintained patient database to identify patients who underwent endovascular treatment of an intracranial aneurysm at our institutes from 2007 to 2017...
March 3, 2018: World Neurosurgery
Ben A Strickland, Robert C Rennert, Joshua Bakhsheshian, Sebina Bulic, Adrian J Correa, Arun Amar, Joseph Carey, Jonathan J Russin
Surgical revascularization continues to play an important role in the management of complex intracranial aneurysms and ischemic cerebrovascular disease. Graft spasm is a common complication of bypass procedures and can result in ischemia or graft thrombosis. The authors here report on the first clinical use of botulinum toxin to prevent graft spasm following extracranial-intracranial (EC-IC) bypass. This technique was used in 3 EC-IC bypass surgeries, 2 for symptomatic carotid artery occlusions and 1 for a ruptured basilar tip aneurysm...
March 2, 2018: Journal of Neurosurgery
Sengottuvel Thanapal, Shyam Duvuru, Treepob Sae-Ngow, Yoko Kato, Katsumi Takizawa
In 1967, the first extracranial to intracranial (EC-IC) arterial anastomosis was performed. Since that time, EC-IC bypass surgery has become a widely accepted surgical treatment for patients with IC stenotic or occlusive atherosclerotic lesions. This article will discuss the history, indications, types, surgical methods, and complications of the EC-IC bypass.
January 2018: Asian Journal of Neurosurgery
Meng Qi, Yan Ma, Liqun Jiao
Extracranial carotid artery aneurysms (ECAA) are less commonly seen disease. It is still difficult to determine the optimal treatment strategy because of limitations in reporting of results and confounding by indications based on the available literature. We depict a hybrid operation combining surgery with balloon occlusion to achieve distal outlet control, aneurysm resection, and reconstruction of parent internal carotid artery for the treatment of extracranial carotid artery aneurysms with good outcomes according to a 2-year follow up...
February 4, 2018: Turkish Neurosurgery
Leif J J Bäck, Katri Aro, Laura Tapiovaara, Pirkka Vikatmaa, Remco de Bree, Verónica Fernández-Álvarez, Luiz P Kowalski, Iain J Nixon, Alessandra Rinaldo, Juan P Rodrigo, K Thomas Robbins, Carl E Silver, Carl H Snyderman, Carlos Suárez, Robert P Takes, Alfio Ferlito
BACKGROUND: Sacrifice and reconstruction of the carotid artery in cases of head and neck carcinoma with invasion of the common or internal carotid artery is debated. METHODS: We conducted a systematic search of electronic databases and provide a review and meta-analysis. RESULTS: Of the 72 articles identified, 24 met the inclusion criteria resulting in the inclusion of 357 patients. The overall perioperative 30-day mortality was 3.6% (13/357)...
February 5, 2018: Head & Neck
Priscille Couture, Thibaud Chazal, Charlotte Rosso, Julien Haroche, Anne Léger, Baptiste Hervier, Sandrine Deltour, Zahir Amoura, Fleur Cohen Aubart
OBJECTIVES: Takayasu arteritis (TA) is a giant cell arteritis usually affecting young women and characterized by inflammatory and ischemic signs of large vessel involvement, including extracranial cerebral arteries. The impact of stroke on TA prognosis has not been well evaluated. METHODS: We performed a retrospective multicenter review of patients with definite TA who experienced at least one stroke and compared the findings to 17 matched patients with TA diagnosis without neurological involvement...
February 1, 2018: Journal of Neurology
Tsukasa Hirano, Takeshi Mikami, Hime Suzuki, Toru Hirano, Yusuke Kimura, Katusya Komatsu, Yukinori Akiyama, Masahiko Wanibuchi, Nobuhiro Mikuni
In neurosurgery, extracranial-to-intracranial (EC-IC) bypass surgery is necessary for patients who have undergone surgery in which the superficial temporal artery (STA) was already used for a different bypass procedure or was damaged. Here, we report our experience with EC-IC bypass using the occipital artery (OA) in cases in which the STA is unavailable, and discuss the technical considerations and pitfalls. Five patients with ischemic-onset moyamoya disease and atherosclerotic disease were included. Two patterns of skin incisions were planned according to the OA pathway and recipient artery location...
January 22, 2018: World Neurosurgery
Masahiro Shin, Masaaki Shojima, Kenji Kondo, Hirotaka Hasegawa, Shunya Hanakita, Akihiro Ito, Taichi Kin, Nobuhito Saito
OBJECTIVE: Skull base meningiomas carry a nonnegligible risk of recurrence. In particular, those arising from the sphenoid wings or middle cranial fossa penetrate into extracranial regions, uncommonly showing massive expansion into the craniofacial regions on recurrence. The role of endoscopic endonasal surgery for those intractable lesions remains unclear. METHODS: We performed endoscopic endonasal craniofacial surgery for 8 recurrent meningiomas invading into the pterygopalatine fossa, infratemporal fossa, nasopharynx, paranasal sinus, or orbit, comprising 2 meningothelial and 1 fibrous meningiomas (World Health Organization [WHO] grade I), 3 atypical and 1 clear cell meningiomas (grade II), and 1 anaplastic meningioma (grade III)...
January 12, 2018: World Neurosurgery
Stephen Monteith, Oded Goren, Ragu Sampath, Eric Lehr, Akshal Patel, Paul J Choi, Joe Iwanaga, Marios Loukas, R Shane Tubbs
BACKGROUND: A few options of extracranial donor vessels exist for utilization 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 five adult cadaveric specimens. The proximal diameter, distal diameter, and the length of the vessel were measured and recorded...
January 12, 2018: World Neurosurgery
Alessandro Narducci, Julia Onken, Marcus Czabanka, Nils Hecht, Peter Vajkoczy
BACKGROUND: Over the last years, intraoperative use of fluorescein is gaining ground in the field of neurosurgery, due to development of a microscope-integrated YELLOW 560 module, with reported experiences in brain malignancies, aneurysms, and arteriovenous malformation surgery. The aim of this study is to determine the feasibility and value of fluorescein videoangiography during bypass procedures. METHODS: The authors enrolled 11 patients who underwent extracranial-to-intracranial bypass for moyamoya disease, atherosclerotic steno-occlusive cerebrovascular disease, and flow replacement during a giant middle cerebral artery (MCA) aneurysm treatment...
January 6, 2018: Acta Neurochirurgica
Leng Ni, Huiling Weng, Zuo Pu, Yuehong Zheng, Bao Liu, Wei Ye, Rong Zeng, Changwei Liu
OBJECTIVE: The objective of this study was to investigate and to compare the early and long-term results of open surgery with endovascular intervention in the treatment of extracranial carotid artery aneurysms (ECCAs). METHODS: A retrospective review of patients diagnosed with ECCAs who underwent open surgical or endovascular treatment from 1997 to 2017 was performed. Clinical characteristics, aneurysm profile, and treatment outcomes were recorded. Early results (<30 days) were evaluated in terms of mortality, perioperative stroke or transient ischemic attack, and cranial nerve injury...
December 7, 2017: Journal of Vascular Surgery
Ning Xu, Kun Zhang, Hao Meng, Tianyi Liu, Honglei Wang
OBJECTIVE: To treat a 13-year-old boy with a spontaneous vertebrobasilar artery dissecting aneurysm in the extracranial artery, which was only 1 mm away from the initial segment of subclavian artery. METHODS: A covered stent was inserted to block the artery of the vertebrobasilar artery dissecting aneurysm. RESULTS: The vertebrobasilar artery dissecting aneurysm was successfully treated without complications. CONCLUSIONS: The procedure is a fast, reliable, effective, and economical technique, particularly suitable for surgeries in settings with limited resources...
February 2018: World Neurosurgery
Marek Iłżecki, Joanna Iłżecka, Stanisław Przywara, Piotr Terlecki, Aneta Grabarska, Andrzej Stepulak, Tomasz Zubilewicz
In patients with atherosclerotic stenosis of the extracranial segment of internal carotid artery, surgical intervention is an effective method to prevent cerebral ischemic stroke. However, this surgical procedure may cause vascular brain damage. The aim of the study was to investigate consequential brain ischemia-reperfusion injury by measuring the cerebral specific marker, neuron-specific (NSE), in serum of patients having undergone internal carotid endarterectomy (CEA). The study involved 25 patients that underwent CEA due to internal carotid artery stenosis...
December 2016: Acta Clinica Croatica
Seong-Eun Park, Ju-Seong Kim, Eun Kyung Park, Kyu-Won Shim, Dong-Seok Kim
OBJECTIVE For patients with moyamoya disease (MMD), surgical intervention is usually required because of progressive occlusion of the internal carotid artery. The indirect bypass method has been widely accepted as the treatment of choice in pediatric patients. However, in adult patients with MMD, the most effective treatment method remains a matter of debate. Here, the authors compared the clinical outcomes from MMD patients treated with either extracranial-intracranial arterial bypass (EIAB; 43 hemispheres) or modified encephaloduroarteriosynangiosis (mEDAS; 75 hemispheres) to investigate whether mEDAS is an effective surgical method for treating adults with symptomatic MMD...
October 27, 2017: Journal of Neurosurgery
Jan-Karl Burkhardt, Sebastian Winklhofer, Jorn Fierstra, Susanne Wegener, Giuseppe Esposito, Andreas Luft, Oliver Bozinov, Luca Regli
OBJECTIVE: To present an algorithm based on clinical and radiologic factors, including magnetic resonance imaging (MRI) perfusion/diffusion mismatch (PDM), for the indication of urgent cerebral bypass in patients with acute ischemic stroke. METHODS: Clinical and radiologic data of 8 consecutive patients undergoing urgent cerebral revascularization for acute ischemic stroke owing to occlusion of internal carotid or middle cerebral artery between 2012 and 2015 were analyzed...
January 2018: World Neurosurgery
Gustav Askaner, Rune Rasmussen, Grethe Schmidt, Eva Løbner Lund
Patients undergoing cerebral revascularization surgery have a relatively high incidence of wound complications. We report a case of heterotopic epithelialization of the dura presenting as a non-healing scalp wound after an extracranial-intracranial (EC-IC) arterial bypass. The scalp wound was revised twice without healing. During the third revision, epithelial tissue was found growing on the dura and was removed. After the epithelial tissue was removed, the wound healed without further complications. This case illustrates the importance of thoroughly examining a non-healing wound to find the cause...
September 30, 2017: Acta Neurochirurgica
Rutao Luo, Faliang Gao, Xiaofeng Deng, Dong Zhang, Yan Zhang
OBJECTIVE: The epidemiology of asymptomatic moyamoya disease (MMD) is still unclear, and the best management remains controversial. The aim of this study is to evaluate the prognosis of these patients with different management, conservative follow-up, or surgical treatment. METHODS: This prospective cohort study screened a series of 696 consecutive MMD patients from 2009-2015. Patients with any episodes of hemorrhage and ischemic stroke or TIA were excluded. Finally, 61 patients who were followed up for at least 12 months were included, with 52 patients who underwent surgical treatment and 9 patients who underwent conservative follow-up...
December 2017: World Neurosurgery
Shunya Hanakita, Stéphanie Lenck, Moujahed Labidi, Kentaro Watanabe, Damien Bresson, Sébastien Froelich
BACKGROUND: In skull base tumors involving the cavernous sinus, indications for aggressive resection are sparse and must be carefully examined because of their invasiveness. With careful evaluation, techniques including internal carotid artery sacrifice with or without extracranial-intracranial bypass may still be an option in some cases. Moreover, previous surgery with the sacrifice of potential donor vessels requires adjusting the revascularization strategy. We describe an occipital artery-middle cerebral artery bypass before skull base tumor resection...
January 2018: World Neurosurgery
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