Result of extracranial-intracranial bypass surgery in the treatment of XXXX : outcomes in 15 cases.

@entity1 @entity548 @entity63 @entity2500 @entity130 @entity439 @entity1188 @entity5487 @entity432 @entity2849 @entity438
OBJECTIVE: The standard treatment strategy of @entity438 includes either endovascular coiling or microsurgical clipping. In certain situations such as in giant or dissecting @entity439 , bypass surgery followed by proximal occlusion or trapping of parent artery is required. METHODS: The authors assessed the result of extracranial-intracranial (EC-IC) bypass surgery in the treatment of @entity438 in one institute between 2003 and 2007 retrospectively to propose its role as treatment modality. The outcomes of 15 @entity1 with complex @entity439 treated during the last 5 years were reviewed. Six male and 9 female @entity1 , aged 14 to 76 years, presented with symptoms related to @entity548 in 6 cases, transient @entity63 attack (TIA) in 2 unruptured cases, and permanent @entity1188 in one, and compressive symptoms in 3 cases. @entity439 were mainly in the internal carotid artery (ICA) in 11 cases, @entity2500 ( @entity2500 ) in 2, posterior cerebral artery (PCA) in one and posterior @entity5487 (PICA) in one case. RESULTS: The types of @entity439 were 8 cases of large to @entity439 , 5 cases of ICA @entity439 , one dissecting @entity439 , and one @entity2849 related to @entity130 . High-flow bypass surgery was done in 6 cases with radial artery graft (RAG) in five and saphenous vein graft (SVG) in one. Low-flow bypass was done in nine cases using superficial temporal artery (STA) in eight and occipital artery (OA) in one case. Parent @entity432 was performed with clipping in 9 @entity1 , with coiling in 4, and with balloon plus coil in 1. Direct @entity439 clip was done in one case. The follow up period ranged from 2 to 48 months (mean 15.0 months). There was no mortality case. The long-term clinical outcome measured by Glasgow outcome scale (GOS) showed good or excellent outcome in 13/15. The overall surgery related morbidity was 20% (3/15) including 2 emergency bypass surgeries due to unexpected parent @entity432 during direct clipping procedure. The short-term postoperative bypass graft patency rates were 100% but the long-term bypass patency rates were 86.7% (13/15). Nonetheless, there was no bypass surgery related morbidity due to occlusion of the graft. CONCLUSION: Revascularization technique is a pivotal armament in managing complex @entity439 and scrupulous prior planning is essential to successful outcomes.
