Abstract 166: Indirect Revascularization for Symptomatic Intracranial Arterial Stenoses: Clinical and Angiographic Outcomes
Objective: Symptomatic intracranial arterial stenoses have a high rate of recurrent stroke despite medical and endovascular treatments. We present clinical and angiographic quantitative outcomes of indirect revascularization for patients with symptomatic intracranial stenosis.
Methods: Patients treated for symptomatic intracranial arterial stenosis by indirect revascularization were included. Patients had failed maximal medical management and were unsuitable for or had failed endovascular therapy. Patients underwent encephaloduroarteriosynangiosis (EDAS) with or without burr holes. Preoperative and postoperative angiograms were evaluated for change in caliber of extracranial blood vessels (superficial temporal artery and middle meningeal artery) and for evidence of neovascularity.
Results: Thirteen patients underwent EDAS. Ischemic symptoms ceased within 3 weeks of surgery in 92.3% of patients and in all patients by 3 months. During the follow-up period (median follow-up 4.5 years) 85% of patients remained symptom-free, returning in a delayed fashion in only 2 (one at 1 year and one at 4 years). No patients treated with EDAS developed strokes or died. All donor blood vessels increased in size relative to preoperatively (average increase of 52% for proximal STA, p=0.01, 74% for midpoint of STA, p=0.01, and 84% for the MMA, p=0.02). In addition, 8 of 11 (73%) patients demonstrated direct spontaneous anastamoses from extracranial to MCA branches and all patients demonstrated angiographic evidence of vascular blush and/or new branches from the STA and/or MMA.
Conclusions: Indirect revascularization appears to be a safe and effective method to reduce TIAs, stroke and death in patients with symptomatic intracranial arterial stenosis. Neovascularity and enlargement of the external carotid branches were observed in all patients and correlated with improvement in ischemic symptoms. Indirect revascularization is an option for patients who have failed medical therapy.
- © 2012 by American Heart Association, Inc.