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EC-IC bypass of acute or chronic cerebral ischemia: a new perspective
EANS Academy. Grigoriev I. 09/25/19; 275592; EP01119
Dr. Iliya Grigoriev
Dr. Iliya Grigoriev

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In classical method of EC-IC bypass described by M.G. Yasargil in 1967 we connect the branch of the superficial temporal artery (STA) to one of the cortical branches (M4 segment) of the middle cerebral artery (MCA). We perform the perfusion study (SPECT in our cases) and angiographic study (we use CT-AG). Then we merge perfusion maps with angiographic studies, outline the region of hypoperfusion, search and mark the recipient intracranial artery (RA) that supply our region of interest. In the next step, we search and mark donor extracranial artery (DA) (usually STA, but in our case, it could be every branch of the external carotid artery) that lie near our RA, outline the extend of boneflap. In the final step, we upload planned data onto the frameless NN, mark all extracranial (DA projection, bone flap borders) and use contact probe before opening dura to plan the dura incision with respect to the planned RA projection. Finally, we perform the EC-IC bypass in classic fashion.
14 patients were operated using this method, 12 (86%) of them have an acute ischemic stroke, 2 (14%) with chronic cerebral ischemia and lowered cerebrovascular reserve. In 10 (71%) cases we perform single EC-IC bypass in 4 (29%) patients double-barrel anastomosis was performed. STA as a donor artery were used in 11 (79%) patients, in 3 (21%) other cases posterior auricular and occipital artery were used. Postoperatively cerebral perfusion changes were assessed by SPECT, in 13 (93%) patients we observe increase in cerebral perfusion (by 263%), in 1 (7%) case there wasn't any change in cerebral perfusion. All patients undergo postop CT scan, and there were not any hemorrhagic complications. All bypasses were patent after 1,3,14 postoperative days, patency was assessed by CT-AG and ultrasound examination.
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