gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Safety of EC-IC bypass surgery – An observational analysis of complication rate and risk factors in 168 direct revascularization procedures

Meeting Abstract

  • G.A. Schubert - Neurochirurgische Klinik, Medizinische Universität Innsbruck, Innsbruck, Österreich
  • P. Biermann - Medizinische Fakultät Heidelberg-Mannheim, Universität Heidelberg, Deutschland
  • C. Weiss - Abteilung für Biomedizinische Statistik, Medizinische Fakultät Heidelberg-Mannheim, Universität Heidelberg
  • M.S. Seiz-Rosenhagen - Neurochirurgische Klinik, Medizinische Universität Innsbruck, Innsbruck, Österreich
  • P. Schmiedek - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg
  • C. Thomé - Neurochirurgische Klinik, Medizinische Universität Innsbruck, Innsbruck, Österreich

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.15.08

doi: 10.3205/12dgnc140, urn:nbn:de:0183-12dgnc1408

Published: June 4, 2012

© 2012 Schubert et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Cerebral revascularization procedures are a treatment option in selected patients with hemodynamic compromise, but recent studies failed to show an immediate benefit. In addition to defining suitable inclusion criteria, it is mandatory to characterize the perioperative complication rate as well as potential risk factors.

Methods: We included 158 consecutive patients with cerebrovascular atherosclerotic or Moyamoya disease undergoing a total of 168 direct revascularization procedures from 2004 to 2009 in our department. Type of underlying pathology, modality of anticoagulation, coagulation disorders, surgical technique, intraoperative complications, postoperative imaging, the need for surgical revision and outcome at time of discharge were analyzed.

Results: Overall complication rate was low with a high bypass patency rate of 97%. Six hemispheres (3.6%) needed to undergo surgical revision for hematoma evacuation, early morbidity was 10.7% with no mortality, and evidence of ischemia in 6.9% of patients. Disease pathology was not associated with a difference in complication rate. Additional placement of EMS led to an increase of hemorrhagic CT findings (p < 0.001), but did not require surgical intervention and did not change outcome. Single anticoagulation was not associated with an increased risk for hemorrhage or revision, but improved outcome (p < 0.05). Ischemia, midline shift and the need for revision aggravated outcome at time of discharge.

Conclusions: Strict selection criteria are mandatory to identify suitable patients for EC-IC bypass surgery, and a detailed characterization of the perioperative complication rate and identification of potential risk factors are warranted. At a high-volume center, the complication rate is low with high bypass patency rate. The risk profile is comparable for patients with MMD and atherosclerotic disease, despite the variation in technique. Single anticoagulation does not increase the risk of hemorrhagic complications and can improve outcome. Longer follow-up than previously seen is required to adequately assess the true efficacy of EC-IC bypass surgery on stroke prevention.