Cargando…

Revisiting flow augmentation bypass for cerebrovascular atherosclerotic vaso-occlusive disease: Single-surgeon series and review of the literature

OBJECTIVE: Despite advances in the nonsurgical management of cerebrovascular atherosclerotic steno-occlusive disease, approximately 15–20% of patients remain at high risk for recurrent ischemia. The benefit of revascularization with flow augmentation bypass has been demonstrated in studies of Moyamo...

Descripción completa

Detalles Bibliográficos
Autores principales: Abdelgadir, Jihad, Haskell-Mendoza, Aden P., Magno, Amanda R., Suarez, Alexander D., Antwi, Prince, Raghavan, Alankrita, Nelson, Patricia, Yang, Lexie Zidanyue, Jung, Sin-Ho, Zomorodi, Ali R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10198506/
https://www.ncbi.nlm.nih.gov/pubmed/37205640
http://dx.doi.org/10.1371/journal.pone.0285982
_version_ 1785044751182987264
author Abdelgadir, Jihad
Haskell-Mendoza, Aden P.
Magno, Amanda R.
Suarez, Alexander D.
Antwi, Prince
Raghavan, Alankrita
Nelson, Patricia
Yang, Lexie Zidanyue
Jung, Sin-Ho
Zomorodi, Ali R.
author_facet Abdelgadir, Jihad
Haskell-Mendoza, Aden P.
Magno, Amanda R.
Suarez, Alexander D.
Antwi, Prince
Raghavan, Alankrita
Nelson, Patricia
Yang, Lexie Zidanyue
Jung, Sin-Ho
Zomorodi, Ali R.
author_sort Abdelgadir, Jihad
collection PubMed
description OBJECTIVE: Despite advances in the nonsurgical management of cerebrovascular atherosclerotic steno-occlusive disease, approximately 15–20% of patients remain at high risk for recurrent ischemia. The benefit of revascularization with flow augmentation bypass has been demonstrated in studies of Moyamoya vasculopathy. Unfortunately, there are mixed results for the use of flow augmentation in atherosclerotic cerebrovascular disease. We conducted a study to examine the efficacy and long term outcomes of superficial temporal artery to middle cerebral artery (STA-MCA) bypass in patients with recurrent ischemia despite optimal medical management. METHODS: A single-institution retrospective review of patients receiving flow augmentation bypass from 2013–2021 was conducted. Patients with non-Moyamoya vaso-occlusive disease (VOD) who had continued ischemic symptoms or strokes despite best medical management were included. The primary outcome was time to post-operative stroke. Time from cerebrovascular accident to surgery, complications, imaging results, and modified Rankin Scale (mRS) scores were aggregated. RESULTS: Twenty patients met inclusion criteria. The median time from cerebrovascular accident to surgery was 87 (28–105.0) days. Only one patient (5%) had a stroke at 66 days post-op. One (5%) patient had a post-operative scalp infection, while 3 (15%) developed post-operative seizures. All 20 (100%) bypasses remained patent at follow-up. The median mRS score at follow up was significantly improved from presentation from 2.5 (1–3) to 1 (0–2), P = .013. CONCLUSIONS: For patients with high-risk non-Moyamoya VOD who have failed optimal medical therapy, contemporary approaches to flow augmentation with STA-MCA bypass may prevent future ischemic events with a low complication rate.
format Online
Article
Text
id pubmed-10198506
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-101985062023-05-20 Revisiting flow augmentation bypass for cerebrovascular atherosclerotic vaso-occlusive disease: Single-surgeon series and review of the literature Abdelgadir, Jihad Haskell-Mendoza, Aden P. Magno, Amanda R. Suarez, Alexander D. Antwi, Prince Raghavan, Alankrita Nelson, Patricia Yang, Lexie Zidanyue Jung, Sin-Ho Zomorodi, Ali R. PLoS One Research Article OBJECTIVE: Despite advances in the nonsurgical management of cerebrovascular atherosclerotic steno-occlusive disease, approximately 15–20% of patients remain at high risk for recurrent ischemia. The benefit of revascularization with flow augmentation bypass has been demonstrated in studies of Moyamoya vasculopathy. Unfortunately, there are mixed results for the use of flow augmentation in atherosclerotic cerebrovascular disease. We conducted a study to examine the efficacy and long term outcomes of superficial temporal artery to middle cerebral artery (STA-MCA) bypass in patients with recurrent ischemia despite optimal medical management. METHODS: A single-institution retrospective review of patients receiving flow augmentation bypass from 2013–2021 was conducted. Patients with non-Moyamoya vaso-occlusive disease (VOD) who had continued ischemic symptoms or strokes despite best medical management were included. The primary outcome was time to post-operative stroke. Time from cerebrovascular accident to surgery, complications, imaging results, and modified Rankin Scale (mRS) scores were aggregated. RESULTS: Twenty patients met inclusion criteria. The median time from cerebrovascular accident to surgery was 87 (28–105.0) days. Only one patient (5%) had a stroke at 66 days post-op. One (5%) patient had a post-operative scalp infection, while 3 (15%) developed post-operative seizures. All 20 (100%) bypasses remained patent at follow-up. The median mRS score at follow up was significantly improved from presentation from 2.5 (1–3) to 1 (0–2), P = .013. CONCLUSIONS: For patients with high-risk non-Moyamoya VOD who have failed optimal medical therapy, contemporary approaches to flow augmentation with STA-MCA bypass may prevent future ischemic events with a low complication rate. Public Library of Science 2023-05-19 /pmc/articles/PMC10198506/ /pubmed/37205640 http://dx.doi.org/10.1371/journal.pone.0285982 Text en © 2023 Abdelgadir et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Abdelgadir, Jihad
Haskell-Mendoza, Aden P.
Magno, Amanda R.
Suarez, Alexander D.
Antwi, Prince
Raghavan, Alankrita
Nelson, Patricia
Yang, Lexie Zidanyue
Jung, Sin-Ho
Zomorodi, Ali R.
Revisiting flow augmentation bypass for cerebrovascular atherosclerotic vaso-occlusive disease: Single-surgeon series and review of the literature
title Revisiting flow augmentation bypass for cerebrovascular atherosclerotic vaso-occlusive disease: Single-surgeon series and review of the literature
title_full Revisiting flow augmentation bypass for cerebrovascular atherosclerotic vaso-occlusive disease: Single-surgeon series and review of the literature
title_fullStr Revisiting flow augmentation bypass for cerebrovascular atherosclerotic vaso-occlusive disease: Single-surgeon series and review of the literature
title_full_unstemmed Revisiting flow augmentation bypass for cerebrovascular atherosclerotic vaso-occlusive disease: Single-surgeon series and review of the literature
title_short Revisiting flow augmentation bypass for cerebrovascular atherosclerotic vaso-occlusive disease: Single-surgeon series and review of the literature
title_sort revisiting flow augmentation bypass for cerebrovascular atherosclerotic vaso-occlusive disease: single-surgeon series and review of the literature
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10198506/
https://www.ncbi.nlm.nih.gov/pubmed/37205640
http://dx.doi.org/10.1371/journal.pone.0285982
work_keys_str_mv AT abdelgadirjihad revisitingflowaugmentationbypassforcerebrovascularatheroscleroticvasoocclusivediseasesinglesurgeonseriesandreviewoftheliterature
AT haskellmendozaadenp revisitingflowaugmentationbypassforcerebrovascularatheroscleroticvasoocclusivediseasesinglesurgeonseriesandreviewoftheliterature
AT magnoamandar revisitingflowaugmentationbypassforcerebrovascularatheroscleroticvasoocclusivediseasesinglesurgeonseriesandreviewoftheliterature
AT suarezalexanderd revisitingflowaugmentationbypassforcerebrovascularatheroscleroticvasoocclusivediseasesinglesurgeonseriesandreviewoftheliterature
AT antwiprince revisitingflowaugmentationbypassforcerebrovascularatheroscleroticvasoocclusivediseasesinglesurgeonseriesandreviewoftheliterature
AT raghavanalankrita revisitingflowaugmentationbypassforcerebrovascularatheroscleroticvasoocclusivediseasesinglesurgeonseriesandreviewoftheliterature
AT nelsonpatricia revisitingflowaugmentationbypassforcerebrovascularatheroscleroticvasoocclusivediseasesinglesurgeonseriesandreviewoftheliterature
AT yanglexiezidanyue revisitingflowaugmentationbypassforcerebrovascularatheroscleroticvasoocclusivediseasesinglesurgeonseriesandreviewoftheliterature
AT jungsinho revisitingflowaugmentationbypassforcerebrovascularatheroscleroticvasoocclusivediseasesinglesurgeonseriesandreviewoftheliterature
AT zomorodialir revisitingflowaugmentationbypassforcerebrovascularatheroscleroticvasoocclusivediseasesinglesurgeonseriesandreviewoftheliterature