19 Bypass for Acute and Chronic Ischemic States

Annick Kronenburg, Erez Nossek, and David Langer

Abstract

Surgical revascularization by direct or indirect bypass in ischemic steno-occlusive diseases aims at restoring cerebral perfusion in hypoperfused brain areas by flow augmentation. An important category of patients in which bypass surgery is indicated is moyamoya vasculopathy (MMV). The indication of neurosurgical bypass in other steno-occlusive diseases like intracranial carotid artery (ICA) occlusion or stenosis is debated. There remains to be a subcategory of symptomatic patients with proven misery perfusion on hemodynamic imaging in which flow augmentation bypass surgery may benefit. In this chapter, we will discuss the indications, patient selection, and technical aspects of cranial bypass surgery in acute and chronic ischemia.

Key words

neurosurgical bypass - revascularization - ischemia - cerebral hemodynamics - stroke - moyamoya - tailor-made surgery

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