Extracranial–Intracranial Cerebral Revascularization: Indications and Results

Abstract

Objective To present a case-series study of extracranial–intracranial (EC–IC) bypass procedures performed in our service and evaluate indications and results.

Method The medical records of 30 patients undergoing 32 EC–IC anastomosis procedures were evaluated. Seventeen patients were male (56.6%). The age ranged from 26 to 85 years (mean: 58.2). The follow-up ranged from 1 to 211 months (mean: 54). We evaluated the indications and complications of the surgical procedures.

Results The bypass procedures comprised 28 STA–MCA anastomosis (87,5%) and four posterior circulation anastomosis. The main indications included cervical internal carotid artery occlusion (19 cases), Moyamoya disease (3 cases), giant aneurysms (3 cases), intracranial arterial stenosis (2 cases), and vertebral–basilar insufficiency (3 cases). On follow-up, graft patency was 93.7%, confirmed in half of the cases by arterial digital subtraction angiography, magnetic resonance angiography, and CT angiography. There was no surgical mortality. Three patients had PO complications (9.3%), including one case of ischemia (3.1%).

Conclusion The EC–IC bypass is a procedure with low morbidity and mortality. The indication of EC–IC bypass surgery for cerebral atherosclerotic disease should not be generalized. The EC–IC bypass can be indicated for cerebral revascularization in Moyamoya disease, intracranial stenosis, and in the management of complex aneurysms. This procedure can be an alternative in the treatment of vertebral–basilar insufficiency.

Resumo

Objetivo Apresentar uma série de casos de anastomose extra-intracraniana (EC-IC) avaliando suas indicações e resultados.

Método Foram avaliados retrospectivamente os prontuários de 30 pacientes submetidos a 32 procedimentos de anastomose EC-IC. Dezessete pacientes eram do sexo masculino (56,6%) com média de idade de 58,2 anos. O período de seguimento variou de um a 211 meses (média: 54). Foram avaliadas as indicações e complicações dos procedimentos cirúrgicos.

Resultados Foram realizadas 28 anastomoses entre a artéria temporal superficial e a cerebral média (87,5%) e quatro anastomoses na circulação posterior. As principais indicações foram oclusão de carótida interna cervical (19 casos), doença de Moyamoya (3 casos), aneurismas gigantes (3 casos), estenose arterial intracraniana (2 casos) e insuficiência vertebrobasilar (3 casos). A patência tardia do bypass confirmada em metade dos casos por angiografia, angiorressonância ou angiotomografia foi de 93,7%. Não houve mortalidade cirúrgica. Um paciente (3,1%) apresentou isquemia no pós-operatório. Outros dois pacientes (6,2%) apresentaram complicações não isquêmicas.

Conclusões A revascularização EC-IC é procedimento de baixa morbidade e mortalidade. A indicação do procedimento para oclusão carotídea não pode ser generalizada. O bypass EC-IC pode ser indicado na doença de Moyamoya, nas estenoses intracranianas e no manejo de aneurismas complexos. Pode ser alternativa no tratamento da insuficiência vertebrobasilar.

Keywords

cerebral revascularization - extracranial–intracranial bypass - superficial temporal artery - middle cerebral artery

Palavras-chave

revascularização cerebral - bypass extra-intracraniano - artéria temporal superficial - artéria cerebral média

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