Extensive Cerebrovascular Arterial Revascularization

Abstract

Patients with extensive and severe stenotic/occlusive lesions in the superior aortic system represent an important category both regarding the challenging therapeutical strategy and planning and their increasing prevalence. Other important arterial beds are additionally affected in these patients: renal, inferior limbs, and coronary. Signs and symptoms pertaining to cerebral ischemia are frequently intricate, asking for a thorough clinical and diagnostic workup. Operative and anesthetic risk is globally increased, and no solution appears as ideal when weighing the hazard against the benefit while choosing between many more smaller-scale operations under more anesthetic acts (and leaving untreated lesions in place for variable periods of time) on one hand and a single more ample reconstruction, on the other. Not least, extensive revascularization in the cerebral territory may complicate with the cerebral hyperperfusion syndrome [1], a severe condition with a grim prognosis. We present in this chapter our experience with cerebrovascular revascularization comprising more than one territory, in the same patient and in a single operative session.