Artikel
Risk of intraoperative ischemia due to temporary vessel occlusion during standard EC/IC bypass surgery
Risiko intraoperativer Ischämie aufgrund temporärer Gefäßokklusion während Standard-EC/IC-Bypasschirurgie
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Autoren
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P. Horn
- Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Mannheim
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T. Kinfe
- Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Mannheim
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P. Schmiedek
- Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Mannheim
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P. Vajkoczy
- Klinik für Neurochirurgie, Universitätsklinikum Mannheim, Mannheim
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Standard extracranial – intracranial arterial (EC/IC) bypass surgery represents a well recognized procedure aiming to augment distal cerebral circulation. The creation of the bypass requires the temporary occlusion of the recipient vessel. Thus, there exists a theoretical concern about the risk of standard EC/IC arterial bypass surgery causing ischemic complications due to temporary vessel occlusion. In the present prospective study, the incidence of intraoperative ischemia was investigated in symptomatic patients with steno-occlusive cerebrovascular disease and existing hemodynamic insufficiency.
Methods: Twenty consecutive patients (12 female, 8 male; mean age 56±13 yrs.) suffering from recurrent transient ischemic events due to occlusive cerebrovascular disease and with approved hemodynamic compromise in functional blood flow (rCBF) studies were enrolled in the present study. Underlying pathology was internal carotid artery (ICA) or MCA occlusion in 7 cases, ICA or MCA stenosis in 2 cases, while 11 patients presented with Moyamoya-syndrom (MMS) or Moyamoya-disease (MMD). Patients underwent clinical examination and MR imaging within 24 hours prior and after surgery.
Results: The incidence of reversible clinical signs of ischemia was 1/20 (5%). In contrast to this, postoperative DWI revealed signs of diffusion disturbances in 2 / 20 (10 %) cases. The observed DWI changes however, were not situated within the dependent vascular territory at risk for ischemia in both cases. The temporary vessel occlusion time ranged between 25 and 42 minutes (mean ± SD: 33±7 min).
Conclusions: EC/IC bypass surgery harbours a very low risk for intraoperative ischemia due to temporary vessel occlusion.
