Abstract
The human brain has an uncompromising requirement for perfusion unlike any other organs. Disturbances in normal blood flow can result from chronic changes relating to atherosclerosis or arteriopathy (e.g., Moyamoya) or can be acute as in the case of vessel occlusion need to treat complex brain aneurysms. Whether acute or chronic, ischemic risk is the final common pathway. Revascularization, in the form of direct bypass surgery, aims to immediately restore normal blood flow to the arterial territory distal to the lesion, thereby averting ischemia. By matching donor blood vessels from the intracranial or extracranial circulation to the recipient blood vessels, the surgeon has the opportunity to make a dramatic effect on what would otherwise be potentially devastating natural history of the disease. In doing so, there is also the potential for serious complications. Herein, we describe the principles of direct bypass surgery and review the nuances and techniques for complication avoidance that have accumulated with a personal experience of over 400 bypass operations.
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References
Powers WJ, Clarke WR, Grubb RL, et al. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the carotid occlusion surgery study randomized trial. JAMA. 2011;306(18):1983–92.
Sanai N, Zador Z, Lawton MT. Bypass surgery for complex brain aneurysms: an assessment of intracranial-intracranial bypass. Neurosurgery. 2009;65(4):670–83.
Mesiwala AH, Sviri G, Fatemi N, Britz GW, Newell DW. Long-term outcome of superficial temporal artery–middle cerebral artery bypass for patients with moyamoya disease in the US. Neurosurg Focus. 2008;24(2):E15.
Guzman R, Lee M, Achrol A, et al. Clinical outcome after 450 revascularization procedures for moyamoya disease: clinical article. J Neurosurg. 2009;111(5):927–35.
Kalani MYS, Zabramski JM, Nakaji P, Spetzler RF. Bypass and flow reduction for complex basilar and vertebrobasilar junction aneurysms. Neurosurgery. 2013;72(5):763–76.
Abla AA, McDougall CM, Breshears JD, Lawton MT. Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients. J Neurosurg. 2016;124(5):1275–86.
Rutledge WC, Choudhri O, Walcott BP, et al. Indirect and direct revascularization of ACTA2 cerebral arteriopathy: feasibility of the superficial temporal artery to anterior cerebral artery bypass with posterior auricular artery interposition graft: case report. J Neurosurg Pediatr. 2016;18(3):339–43.
Pisapia JM, Walcott BP, Nahed BV, Kahle KT, Ogilvy CS. Cerebral revascularization for the treatment of complex intracranial aneurysms of the posterior circulation: microsurgical anatomy, techniques and outcomes. J Neurointerv Surg. 2011;3(3):249–54.
Lawton MT, Walcott BP, Stapleton CJ. Middle cerebral artery-to-A1 anterior cerebral artery intracranial-intracranial bypass for ruptured dissecting pseudoaneurysm: 3-dimensional operative video. Oper Neurosurg. 2016;12(1):91–2.
Abud DG, Spelle L, Piotin M, Mounayer C, Vanzin JR, Moret J. Venous phase timing during balloon test occlusion as a criterion for permanent internal carotid artery sacrifice. Am J Neuroradiol. 2005;26(10):2602–9.
Sugawara Y, Kikuchi T, Ueda T, et al. Usefulness of brain SPECT to evaluate brain tolerance and hemodynamic changes during temporary balloon occlusion test and after permanent carotid occlusion. J Nucl Med. 2002;43(12):1616–23.
Jarvis MA, Jarvis CL, Jones PR, Spyt TJ. Reliability of Allen’s test in selection of patients for radial artery harvest. Ann Thorac Surg. 2000;70(4):1362–5.
Starnes SL, Wolk SW, Lampman RM, et al. Noninvasive evaluation of hand circulation before radial artery harvest for coronary artery bypass grafting. J Thorac Cardiovasc Surg. 1999;117(2):261–6.
Krasopoulos G, Brister SJ, Beattie WS, Buchanan MR. Aspirin “resistance” and risk of cardiovascular morbidity: systematic review and meta-analysis. BMJ. 2008;336(7637):195–8.
Matetzky S, Shenkman B, Guetta V, et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation. 2004;109(25):3171–5.
Price MJ, Endemann S, Gollapudi RR, et al. Prognostic significance of post-clopidogrel platelet reactivity assessed by a point-of-care assay on thrombotic events after drug-eluting stent implantation. Eur Heart J. 2008;29(8):992–1000.
Roberts JD, Wells GA, Le May MR, et al. Point-of-care genetic testing for personalisation of antiplatelet treatment (RAPID GENE): a prospective, randomised, proof-of-concept trial. Lancet. 2012;379(9827):1705–11.
Shuaib A, Butcher K, Mohammad AA, Saqqur M, Liebeskind DS. Collateral blood vessels in acute ischaemic stroke: a potential therapeutic target. Lancet Neurol. 2011;10(10):909–21.
Todd MM, Hindman BJ, Clarke WR, Torner JC. Mild intraoperative hypothermia during surgery for intracranial aneurysm. N Engl J Med. 2005;352(2):135–45.
Ching S, Purdon PL, Vijayan S, Kopell NJ, Brown EN. A neurophysiological–metabolic model for burst suppression. Proc Natl Acad Sci U S A. 2012;109(8):3095–100.
Gavaghan TP, Gebski V, Baron D. Immediate postoperative aspirin improves vein graft patency early and late after coronary artery bypass graft surgery. A placebo-controlled, randomized study. Circulation. 1991;83(5):1526–33.
Chesebro JH, Fuster V, Elveback LR, et al. Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations. N Engl J Med. 1984;310(4):209–14.
Van der Meer J, Hillege H, van Gilst W, et al. Prevention of one-year vein-graft occlusion after aortocoronary-bypass surgery: a comparison of low-dose aspirin, low-dose aspirin plus dipyridamole, and oral anticoagulants. Lancet. 1993;342(8866):257–64.
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Walcott, B.P., Lawton, M.T. (2018). Direct Bypass Surgery: Principles, Nuances, and Complication Avoidance. In: Gandhi, C., Prestigiacomo, C. (eds) Cerebrovascular and Endovascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-65206-1_18
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