Long-term results of surgical brain revascularization in patients with chronic cerebral insufficiency

Abstract

The study objective is to evaluate long-term effectiveness of extracranial-intracranial (EC-IC) bypass in patients with symptomatic occlusion of the internal carotid artery (ICA).Materials and methods. From 2013 to 2015, 129 patients (aged 41 to 78, average age – 60 years) were applied EC-IC bypass on the side of ICA symptomatic occlusion at the Department of Neurosurgery of N.V. Sklifosovsky Research Institute for Emergency Medicine. We revealed right ICA occlusion in 54 patients, left ICA occlusion – in 67, bilateral occlusion – in 8. Symptomatic ICA occlusion was 5 times more often in men. We assessed neurological status in 1, 2, and 3 years using modified Rankin Scale, National Institutes of Health Stroke Scale, and Rivermead Mobility Index. Computed tomography (CT) angiography of extracranial and intracranial arteries, ultrasound of the anastomosis zone, single-photon emission computed tomography (SPECT) were performed.Results. In the early postoperative period, according to CT angiography and ultrasound, the anastomosis functioned in 125 (97 %) patients; improvement of regional cerebral perfusion according to SPECT was observed in all examined patients (n = 62). We examined 31 patients in the remote postoperative period. According to CT angiography and ultrasound, anastomosis functioned in 30 (97 %) patients, 30 (97 %) patients demonstrated positive dynamics of neurological status and brain perfusion. There were no repeated ischemic-type cerebral circulatory disorders and repeated transient ischemic attacks in the long-term postoperative period.Conclusion. Positive dynamics after EC-IC bypass was revealed both in early and in distant periods (within 1–3 years). During the surgery, it is necessary to take into account cases of ischemic strokes or transient ischemic attack, ICA occlusion according to CT angiography, a decrease in cerebrovascular reserve (<10 %) according to brain SPECT when tested with acetazolamide. To prevent complications, EC-IC bypass should not be used in patients with severe neurological impairments and concomitant pathology. Properly selected patients and postoperative drug therapy helps prevent repeated ischemic cerebral circulatory disorders.Conflict of interest. The authors declare no conflict of interest.Informed consent. All patients gave written informed consent to participate in the study.