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Protective STA-MCA bypass to prevent brain ischemia during high-flow bypass surgery: case series of 10 patients

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

High-flow extracranial-intracranial bypass is associated with a significant risk of ischemic stroke. The goal of this study is to evaluate the effectiveness of STA-MCA bypass preceding a high-flow bypass as a means of protecting the brain from ischemia during the high-flow bypass anastomosis in patients with otherwise untreatable aneurysms.

Materials and method

This prospective study included 10 consecutive patients treated for complex/giant aneurysm using a previous combined STA-MCA bypass and high-flow EC-IC bypass between June 2016 and January 2018 when classical endovascular or microsurgical exclusion was estimated too risky. Early cranial Doppler, MRI, CT scan, and conventional angiography were performed in each patient to confirm patency of bypasses, measure flow in the anastomoses, detect any ischemic lesions, and evaluate exclusion of the aneurysm.

Results

The mean age at treatment was 55 years (range 34 to 67). The mean time of microsurgical procedure was 11 h (range 9 to 12). In all patients, the high-flow bypass was patent intraoperatively and complete occlusion of aneurysm was obtained. No ischemic lesions were noted on early MRI. One patient died from a large hemispheric infarction related to a common carotid artery dissection 10 days after the microsurgical procedure and immediate postoperative epidural hematoma was noted in one other patient.

Conclusion

In this study, we described the use of a protective STA-MCA bypass, performed prior to the high-flow bypass, in order to reduce the risk of perioperative ischemic lesions without increasing the morbidity of the surgical procedure. This treatment paradigm was feasible in all ten patients without complications related to the STA-MCA anastomosis.

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital Nord, Lille University Hospital, Rue E. Laine, 59037, Lille cedex, France

    Rabih Aboukais & Jean-Paul Lejeune

  2. INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, University of Lille, 59000, Lille, France

    Rabih Aboukais, Maximilien Vermandel & Jean-Paul Lejeune

  3. Department of Neurosurgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium

    Barbara Verbraeken & Tomas Menovsky

  4. Department of Neuroradiology, Hospital Nord, Lille University Hospital, Lille, France

    Xavier Leclerc, Corinne Gautier & Nicolas Bricout

Authors
  1. Rabih Aboukais
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  2. Barbara Verbraeken
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  3. Xavier Leclerc
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  4. Corinne Gautier
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  5. Maximilien Vermandel
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  7. Jean-Paul Lejeune
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  8. Tomas Menovsky
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Correspondence to Rabih Aboukais.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Lille University Hospital/ Ethic committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study, formal consent is not required.

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Aboukais, R., Verbraeken, B., Leclerc, X. et al. Protective STA-MCA bypass to prevent brain ischemia during high-flow bypass surgery: case series of 10 patients. Acta Neurochir 161, 1207–1214 (2019). https://doi.org/10.1007/s00701-019-03906-4

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  • DOI: https://doi.org/10.1007/s00701-019-03906-4

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