Tailored Double-Barrel Bypass Surgery Using an Occipital Artery Graft for Unstable Intracranial Vascular Occlusive Disease

2017 ◽  
Vol 101 ◽  
pp. 813.e5-813.e9 ◽  
Author(s):  
Yeongu Chung ◽  
Sung Ho Lee ◽  
Jiwook Ryu ◽  
Johnho Kim ◽  
Sang Bong Chung ◽  
...  
Keyword(s):  
Bypass Surgery ◽  
Occlusive Disease ◽  
Occipital Artery ◽  
Artery Graft ◽  
Vascular Occlusive Disease

scholarly journals Vascular adaptation of the internal thoracic artery graft early and late after bypass surgery

2008 ◽  
Vol 136 (4) ◽  
pp. 876-883 ◽  
Author(s):  
Beat H. Walpoth ◽  
Markus Schmid ◽  
Anna Schwab ◽  
Andreas Bosshard ◽  
Friedrich Eckstein ◽  
...  
Keyword(s):  
Bypass Surgery ◽  
Internal Thoracic Artery ◽  
Vascular Adaptation ◽  
Artery Graft ◽  
Internal Thoracic Artery Graft

Abstract 74: Improvement in Cerebral Hemodynamic Parameters and Outcome after Superficial Temporal Artery- Middle Cerebral Artery Bypass in Patients with Severe Steno-occlusive Disease of Intracranial Carotid and Middle Cerebral Artery

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Leonard Yeo ◽  
Prakash Paliwas ◽  
Aftab Ahmad ◽  
Arvind K Sindha ◽  
Hockluen Teoh ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Occlusive Disease ◽  
Stroke Recurrence ◽  
Hemodynamic Parameters ◽  
Bypass Group ◽  
Hmpao Spect

Background and Objective: Older and the recent extracranial-intracranial (EC/IC) bypass trials for symptomatic carotid occlusion failed to demonstrate reduction in stroke recurrence. However, role of superficial temporal artery-middle cerebral artery (STA-MCA) bypass in patients with symptomatic intracranial steno-occlusive disease has been evaluated scarcely. We evaluated serial changes in various cerebral hemodynamic parameters in patients with severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) and impaired cerebral vasodilatory reserve (CVR), treated with STA-MCA bypass surgery or medical treatment. Methods: Patients with severe steno-occlusive disease of intracranial ICA or MCA underwent transcranial Doppler (TCD) ultrasonography and CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-challenged hexamethylpropyleneamine-oxime single-photon emission computed tomography (HMPAO-SPECT). STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. All patients underwent TCD and SPECT at 4±1 months and followed-up for cerebral ischemic events. Results: A total of 112patients (73males, mean age 56yrs; range 23-78yrs) were included. HMPAO-SPECT demonstrated impaired CVR in 77 (69%) patients. Of them, 46 underwent STA-MCA bypass while 31 received best medical treatment. TCD and acetazolamide-challenged HMPAO-SPECT repeated 4±1months showed significant improvement in STA-MCA bypass group. During follow-up (mean 34months; range 18-39months), only 6/46 (13%) patients in bypass group developed cerebral ischemic events as compared to 14/31 (45%) cases on medical therapy (absolute risk-reduction 32%, p=0.008). Conclusion: STA-MCA bypass surgery in carefully selected patients with symptomatic severe intracranial steno-occlusive disease results in significant improvement in hemodynamic parameters and reduction in stroke recurrence.

Abstract T MP26: Role of 99tc-hmpao Spect in the Assessment of Cerebral Hemodynamic Parameters After Superficial Temporal Artery- Middle Cerebral Artery Bypass in Patients With Severe Steno-Occlusive Disease of Intracranial Carotid and Middle Cerebral Artery

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Amit Batra ◽  
Arvind K Sinha ◽  
Leonard L Yeo ◽  
Rahul Rathakrishnan ◽  
Prakash Paliwal ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Occlusive Disease ◽  
Hemodynamic Parameters ◽  
Bypass Group ◽  
Hmpao Spect ◽  
Cerebral Ischemic

Background and Objective: Although superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in patients with symptomatic carotid occlusion failed to demonstrate any benefit, its role in symptomatic intracranial steno-occlusive disease has been evaluated scarcely. We evaluated changes in hemodynamic parameters in patients with severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) who underwent STA-MCA bypass for impaired cerebral vasodilatory reserve (CVR). Methods: Patients with severe steno-occlusive disease of intracranial ICA or MCA underwent transcranial Doppler (TCD) evaluation and CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-challenged 99Tc-HMPAO-SPECT. STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. TCD and SPECT were repeated in all patients at 4±1 months and they were followed-up for cerebral ischemic events. Results: Of the 126 patients (80 male, mean age 56yrs; range 23-78yrs) that fulfilled our inclusion criteria, 84 (67%) showed impaired CVR HMPAO-SPECT. Fifty (60%) of them underwent STA-MCA bypass while 34(40%) received best medical treatment. TCD and acetazolamide-challenged HMPAO-SPECT repeated 4±1 months after surgery showed significant improvement in STA-MCA bypass group. TCD BHI improved from a median (IQR) of -0.05 to 1.1 (p<0.001). Compared to 98% patients with impaired CVR on pre-operative SPECT, only 20% showed abnormal results on post-operative imaging (p<0.001). During follow-up (mean 35 months; range 8 to 49months), only 6/50 (12%) patients in bypass group developed cerebral ischemic events as compared to15/34 (44%) cases on medical therapy (absolute risk reduction 32%, p=0.006). Conclusion: 99Tc-HMPAO SPECT with acetazolamide challenge is a reliable tool for the assessment of cerebral vasodilatory reserve in patients with severe steno-occlusive disease of intracranial ICA or MCA. STA-MCA bypass surgery in carefully selected patients results in significant improvement in hemodynamic parameters and reduction in stroke recurrence.

scholarly journals Ten year outcomes after bypass surgery in aortoiliac occlusive disease

2012 ◽  
Vol 82 (6) ◽  
pp. 365 ◽  
Author(s):  
Gwan-Chul Lee ◽  
Shin-Seok Yang ◽  
Keun-Myoung Park ◽  
Yangjin Park ◽  
Young-Wook Kim ◽  
...  
Keyword(s):  
Bypass Surgery ◽  
Occlusive Disease ◽  
Aortoiliac Occlusive Disease

The Results of Superficial Femoral, Popliteal, and Tibial Artery Stenting for Peripheral Vascular Occlusive Disease

2005 ◽  
Vol 71 (11) ◽  
pp. 905-910 ◽  
Author(s):  
Joe H. Morgan ◽  
Charles E. Wall ◽  
D. Benjamin Christie ◽  
Richard L. Harvey ◽  
Maurice M. Solis
Keyword(s):  
Limb Salvage ◽  
Ankle Brachial Index ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Primary Therapy ◽  
Peripheral Vascular Occlusive Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Angioplasty And Stenting ◽  
Vascular Occlusive Disease

The purpose of this study was to evaluate the patentcy rates and physiological effectiveness of angioplasty and stenting as a primary therapy for superficial femoral (SFA), popliteal (POP), and tibial (TIB) arterial occlusive disease. Seventy-eight patients had stents placed in the infra-inguinal vessels between January 1, 2001, and July 31, 2004. We collected data on patient demographics, symptoms, as well as pre- and postprocedure ankle-brachial index (ABI) and angio-graphic findings. Patency rates at 6 months, 12 months, and 24 months were analyzed by life table methods. Thirty-one men and 47 women had a mean age of 68 years (range 36–94 years). Risk factors included diabetes in 50 per cent, hypertension in 79 per cent, smoking in 41 per cent, and end-stage renal disease in 10 per cent. The indications for intervention were claudication in 52 per cent and limb salvage in 48 per cent of patients. Stents were placed in the SFA in 54 patients (69%), in the POP in 15 patients (18%), and in the TIB artery in 6 patients (8%). Average follow-up was 11.2 months. The mean postprocedural increase in ABI was 0.29. The 6-month, 1-year, and 2-year primary patency rates were 83 per cent, 58 per cent, and 47 per cent, respectively. Limb salvage was achieved in 66 per cent of patients treated for limb-threatening ischemia. There was one major and three minor complications. Stenting of the infra-inguinal vessels has a low morbidity, high success rate, and acceptable patency and limb-salvage rates.

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