Results of extraintracranial microvascular revascularization in symptomatic occlusive-stenotic affections of brachiocephalic arteries

Keywords: cerebral revascularization; microvascular anastomosis; stenosis/occlusion of brachio-cephalic arteries; neuroradiolog

Abstract

Objective. To specify the indications for creation of extraintracranial microvascular anastomosis and estimation of its efficacy in occlusive-stenotic pathology of brachio-cephalic arteries, basing on complex estimation of cerebral hemodynamics

Materials and methods. Creation of extraintracranial microvascular anastomosis was analyzed in 14 patients with occlusive-stenotic pathology of brachio-cephalic arteries, to whom duplex scanning of the head and neck vessels was conducted, as well as multispiral computed tomographic angiography and cerebral angiography. Hemodynamical estimation of cerebral blood circulation was conducted, using multispiral computed tomographical perfusion.

Results. Multiple occlusive-stenotic pathology of brachiocephalic arteries with predominantly one-sided occlusion or stenosis of carotid arteries - in 14.3% with isolated affection and in 14.3% with cerebral hemodynamical disorders - were diagnozed in 71.4% of patients. Satisfactory passability of extraintracranial microvascular anastomosis, clinical efficacy, improvement of cerebral perfusion were confirmed in all observations in accordance to results of neuro-psychological testing and complex radiological examination. Secondary insult was not registered in no one patient.

Conclusion. Symptomatic affection of carotid arteries, connected with cerebral hemodynamics disorder in combination with cognitive deficiency, constitutes the indications for extraintracranial anastomosis formation in occlusion-stenotic pathology of brachiocephalic arteries. Creation of extraintracranial microvascular anastomosis constitutes the effective preventive procedure for insult in patients, suffering this vascular pathology.

Author Biographies

O. Yu. Harmatina, Romodanov Neurosurgery Institute, Kyiv

Harmatina Olha Yu., MD, PhD (Med),

Neuroradiology Department,

Romodanov Neurosurgery Institute,

32 Platona Mayborody Str., 04050, Kyiv, Ukraine

+38 (044) 483-06-68,

E-mail: harmatina@ukr.net

 https://orcid.org/0000-0002-1443-4411

V. V. Moroz, Romodanov Neurosurgery Institute, Kyiv

Moroz Volodymyr V., MD, PhD (Med),

Head of Emergency Department of Vascular Neurosurgery

Romodanov Neurosurgery Institute,

32 Platona Mayborody Str., 04050, Kyiv, Ukraine

+38 (044) 483-07-25

E-mail: moroz.doc@ukr.net

https://orcid.org/0000-0002-9224-1746

References

1. Soinne L, Helenius J, Tatlisumak T, Saimanen E, Salonen O, Lindsberg PJ, Kaste M. Cerebral hemodynamics in asymptomatic and symptomatic patients with high-grade carotid stenosis undergoing carotid endarterectomy. Stroke. 2003 Jul;34(7):1655-61. doi:10.1161/01.STR.0000075605.36068.D9.
2. Powers WJ, Press GA, Grubb RL Jr, Gado M, Raichle ME. The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation. Ann Intern Med. 1987 Jan;106(1):27-34. PMID: 3491558
3. Garrett MC, Komotar RJ, Starke RM, Merkow MB, Otten ML, Sciacca RR, et al. The efficacy of direct extracranial-intracranial bypass in the treatment of symptomatic hemodynamic failure secondary to athero-occlusive disease: a systematic review. Clin Neurol Neurosurg. 2009 May;111(4):319-26. doi: 10.1016/j.clineuro.2008.12.012.
4. Koenig M, Kraus M, Theek C, Klotz E, Gehlen W, Heuser L. Quantitative assessment of the ischemic brain by means of perfusion-related parameters derived from perfusion CT. Stroke. 2001 Feb;32(2):431-7. PMID: 11157178.
5. Chaves CJ, Staroselskaya I, Linfante I, Llinas R, Caplan LR, Warach S. Patterns of perfusion-weighted imaging in patients with carotid artery occlusive disease. Arch Neurol. 2003 Feb;60(2):237-42. PMID: 12580709.
6. Waaijer A, van der Schaaf IC, Velthuis BK, Quist M, van Osch MJ, Vonken EP, van Leeuwen MS, et al. Reproducibility of quantitative CT brain perfusion measurements in patients with symptomatic unilateral carotid artery stenosis. AJNR Am J Neuroradiol. 2007 May;28(5):927-32. PMID: 17494672.
7. Waaijer A, van Leeuwen MS, van Osch MJ, van der Worp BH, Moll FL, Lo RT, et al. Changes in cerebral perfusion after revascularization of symptomatic carotid artery stenosis: CT measurement. Radiology. 2007 Nov;245(2):541-8. doi:10.1148/radiol.2451061493.
8. Low SW, Teo K, Lwin S, Yeo LL, Paliwal PR, Ahmad A, et al. Improvement in cerebral hemodynamic parameters and outcomes after superficial temporal artery-middle cerebral artery bypass in patients with severe stenoocclusive disease of the intracranial internal carotid or middle cerebral arteries. J Neurosurg. 2015 Sep;123(3):662-9. doi: 10.3171/2014.11.JNS141553.
9. Patel HC, McNamara IR, Al-Rawi PG, Kirkpatrick PJ. Improved cerebrovascular reactivity following low flow EC/IC bypass in patients with occlusive carotid disease. Br J Neurosurg. 2010 Apr;24(2):179-84. doi: 10.3109/02688690903536603.
10. Dubovoy AV, Ovsyannikov KS, Guzhin VE, Cherepanov AV, Galaktionov DM, Perfil’ev AM, Sosnov AO. The use of high-flow extracranial-intracranial artery bypass in pathology of the cerebral and brachiocephalic arteries: technical features and surgical outcomes. Zh Vopr Neirokhir Im N N Burdenko. 2017;81(2):5-21. doi: 10.17116/neiro20178125-21. [In Russian].
11. Inoue T, Ohwaki K, Tamura A, Tsutsumi K, Saito I, Saito N. Extracranial-intracranial bypass for internal carotid/middle cerebral atherosclerotic steno-occlusive diseases in conjunction with carotid endarterectomy for contralateral cervical carotid stenosis: clinical results and cognitive performance. Neurosurg Rev. 2016 Oct;39(4):633-41. doi: 10.1007/s10143-016-0717-8.
12. Neff KW, Horn P, Dinter D, Vajkoczy P, Schmiedek P, Düber C. Extracranial-intracranial arterial bypass surgery improves total brain blood supply in selected symptomatic patients with unilateral internal carotid artery occlusion and insufficient collateralization. Neuroradiology. 2004 Sep;46(9):730-7. doi:10.1007/s00234-004-1252-9.
13. Kuroda S, Houkin K. Moyamoya disease: current concepts and future perspectives. Lancet Neurol. 2008 Nov;7(11):1056-66. doi: 10.1016/S1474-4422(08)70240-0.
14. Weinberg DG, Arnaout OM, Rahme RJ, Aoun SG, Batjer HH, Bendok BR. Moyamoya disease: a review of histopathology, biochemistry, and genetics. Neurosurg Focus. 2011 Jun;30(6):E20. doi: 10.3171/2011.3.FOCUS1151.
15. Fujimura M, Bang OY, Kim JS. Moyamoya Disease. Front Neurol Neurosci. 2016;40:204-220. doi:10.1159/000448314.
Published
2018-11-01
Section
General Problems of Surgery