scholarly journals Patients Receiving Extracranial to Intracranial Bypass for Atherosclerotic Vessel Occlusion Today Differ Significantly From the COSS Population

Stroke ◽  
2021 ◽  
Vol 52 (10) ◽  
Author(s):  
Lars Wessels ◽  
Nils Hecht ◽  
Peter Vajkoczy
Keyword(s):  
Cerebrovascular Disease ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Multivessel Disease ◽  
Vessel Occlusion ◽  
Ischemic Attack

Background and Purpose: Despite the findings reported in the COSS (Carotid Occlusion Surgery Study), patients with atherosclerotic cerebrovascular disease continue to be referred for superficial temporal artery to middle cerebral artery bypass surgery. Here, we determined how today’s patients differ from the population reported in COSS. Methods: We retrospectively analyzed all patients that were referred to our Department for superficial temporal artery to middle cerebral artery bypass surgery of atherosclerotic cerebrovascular disease following the publication of COSS. Results: Between 2012 and 2019, 179 patients were referred for 186 bypass surgeries. Ninety-one (51%) patients suffered atherosclerotic, unilateral internal carotid occlusion and 88 (49%) atherosclerotic multivessel disease. All patients had received intensive medical management. A single transitory ischemic attack or ischemic stroke within the last 120 days according to the inclusion criteria of COSS occurred in only 36 out of 179 (20%) patients, whereas 27 out of 179 (15%) suffered >1 transitory ischemic attack within 120 days, 109 out of 179 (61%) had recurrent minor ischemic stroke, and 7 out of 179 (4%) were hemodynamically unstable and required blood pressure maintenance. The distribution of symptoms did not differ between atherosclerotic unilateral internal carotid artery occlusion and atherosclerotic multivessel disease ( P =0.376) but hemodynamic impairment was significantly greater in atherosclerotic multivessel disease ( P <0.001 for atherosclerotic multivessel disease versus atherosclerotic unilateral internal carotid artery occlusion). The overall perioperative stroke rate was 4.3%. Conclusions: Patients referred for flow augmentation surgery today appear to suffer more severe symptoms and vessel occlusion patterns than patients reported in COSS. A new, carefully designed randomized controlled trial appears warranted, considering the still poor prognosis of severe atherosclerotic cerebrovascular disease.

Intracranial vascular anastomosis using the microanastomotic system

1998 ◽  
Vol 89 (4) ◽  
pp. 676-681 ◽  
Author(s):  
David W. Newell ◽  
Andrew T. Dailey ◽  
Stephen L. Skirboll
Keyword(s):  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Collateral Flow ◽  
Content Type ◽  
History Of ◽  
End To End ◽  
Fine Print

✓ The authors describe the use of a microanastomotic device to perform intracranial end-to-end vascular anastomoses. Direct end-to-end anastomosis was performed between the superficial temporal artery and branches of the middle cerebral artery (MCA) in three patients. Two patients had moyamoya disease, with severe proximal MCA disease, and one suffered an internal carotid artery occlusion with poor collateral flow. All patients reported a history of recent ischemic symptoms. Each anastomosis was accomplished in less than 15 minutes with technically satisfactory results. Postoperative angiographic studies demonstrated patency of the bypasses in all patients.

External Carotid Endarterectomy Followed by Superficial Temporal Artery to Middle Cerebral Artery Anastomosis for Internal Carotid Artery Occlusion with Advanced Ipsilateral External Carotid Stenosis

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS395-ONS399 ◽  
Author(s):  
Takakazu Kawamata ◽  
Yoshikazu Okada ◽  
Akitsugu Kawashima ◽  
Kohji Yamaguchi ◽  
Tomokatsu Hori
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
External Carotid ◽  
Cerebrovascular Complications

Abstract Objective: For patients with internal carotid artery occlusion with advanced narrowing of the ipsilateral external carotid artery (ECA), we performed preventive carotid endarterectomy (CEA) for the ECA stenosis before superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis for internal carotid artery occlusion. Methods: Between August 2002 and July 2005, we treated seven patients with such lesions, six men and one woman, ranging in age from 52 to 66 years (median, 60 yr). Before STA-MCA anastomosis, we performed preventive CEA for advanced ECA stenosis (&gt;70%) to ensure sufficient blood flow to the STA. STA-MCA double anastomoses were performed more than 1 month after the CEA. Postoperative cerebrovascular complications and carotid restenosis were investigated. Results: All patients in the present series had an excellent postoperative course without cerebrovascular complications during either the CEA or STA-MCA anastomosis phase. Furthermore, no postoperative carotid restenosis occurred, and all STA-MCA anastomoses were patent during a mean follow-up period of 35.6 months. Conclusion: The present study suggests that surgical management by external CEA followed by STA-MCA anastomosis is safe and effective for patients with internal carotid artery occlusion and advanced stenosis of the ipsilateral ECA.

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