Outcomes of Arterial Bypass for Posterior Circulation Atherosclerosis: A Case Series.
Publication/Presentation Date
2-1-2023
Abstract
BACKGROUND: Extracranial-intracranial bypass is an effective treatment option for moyamoya disease and in well-selected cases of anterior circulation intracranial atherosclerotic disease; however, the effectiveness of bypass is less evident in posterior circulation atherosclerosis. Updated surgical techniques and clinical guidelines necessitate modern appraisal of arterial bypass for symptomatic patients with posterior circulation atherosclerotic disease who are refractory to medical management.
OBJECTIVE: To evaluate the complications, graft patency, and postoperative outcomes of arterial bypass for posterior circulation intracranial atherosclerotic disease.
METHODS: Perioperative records of consecutive bypass patients were retrospectively evaluated to determine the clinical course and surgical outcomes.
RESULTS: Arterial bypass was performed in 8 cases with a median age of 62 years. All 8 patients underwent direct bypass with an autologous occipital artery donor vessel. Recipient vessel selection varied on a case-by-case basis, with the superior cerebellar artery used in 4 cases, the posterior inferior cerebellar artery in 3 cases, and the anterior inferior cerebellar artery in 1 case. There were no significant intraoperative or postoperative complications. Postoperatively, all 8 patients displayed clinical improvement of their preoperative symptoms, with a significant decrease of 2.5 points on the modified Rankin Scale (P < .001). Postoperative imaging confirmed full graft patency in 7 patients and partial patency in 1 patient.
CONCLUSION: Excellent postoperative outcomes and no major complications after posterior circulation arterial bypass for intracranial atherosclerotic disease highlight the utility of this intervention for the treatment of medically refractory or symptomatic posterior circulation intracranial atherosclerotic disease. Larger studies may be valuable to validate these findings.
Volume
24
Issue
2
First Page
145
Last Page
153
ISSN
2332-4260
Published In/Presented At
Farooq, J., Piper, K., Yeung, E., Zhang, J., van Loveren, H., Agazzi, S., & Lau, T. (2023). Outcomes of Arterial Bypass for Posterior Circulation Atherosclerosis: A Case Series. Operative neurosurgery (Hagerstown, Md.), 24(2), 145–153. https://doi.org/10.1227/ons.0000000000000481
Disciplines
Medicine and Health Sciences
PubMedID
36637299
Department(s)
Department of Surgery, USF-LVHN SELECT Program, USF-LVHN SELECT Program Students
Document Type
Article