Predictors of patency of excimer laser–assisted nonocclusive extracranial-to-intracranial bypasses

Clinical article

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Object

Excimer laser–assisted nonocclusive anastomosis (ELANA) is a technique that can be used for extracranial-to-intracranial (EC-IC) bypasses, without the necessity of temporary occlusion of the donor or recipient artery. Information on predictors of patency of EC-IC bypasses in general and the ELANA bypass in particular is sparse. The authors studied 159 ELANA EC-IC bypasses to find predictors of patency.

Methods

From a prospective database of patients who underwent EC-IC bypass surgery, 143 consecutive patients who underwent a total of 159 ELANA bypasses were studied. The associations of patient characteristics, surgical aspects, and technical aspects specific to the ELANA technique with intraoperative and postoperative bypass patency were studied using logistic regression analysis.

Results

At the end of the operation, 146 (92%) of the 159 bypasses were patent. A first attempt to create a bypass was almost 8 times more likely (OR 7.6, 95% CI 2.1–27.5; p = 0.02) to result in a patent bypass than a second attempt. Administration of a small amount of heparin during the operation was also associated with bypass patency (OR 5.2, 95% CI 1.1–24.9; p = 0.04). One hundred twenty-three (77%) of the 159 bypasses were functional at patency assessments during the 1st month after the operation. Older age (OR 1.043 for every year of increase in age, 95% CI 1.010–1.076; p = 0.01), male sex (OR 2.9, 95% CI 1.3–6.5; p = 0.01), and high intraoperative bypass flow (OR 1.017 for every milliliter per minute increase in flow, 95% CI 1.004–1.030; p = 0.01) were associated with postoperative bypass patency.

Conclusions

Attempts to create a second EC-IC ELANA bypass after the first one are more likely to fail, whereas administration of heparin to the patient during the procedure increases the intraoperative bypass patency rate. Postoperative patency results are better in male and in older patients. Intraoperative bypass flow measurements are essential because high bypass flow is an important determinant of postoperative patency.

Abbreviations used in this paper: EC-IC = extracranial-intracranial; ELANA = excimer laser–assisted nonocclusive anastomosis; ICA = internal carotid artery; MCA = middle cerebral artery.
Article Information

Contributor Notes

Address correspondence to: Bon H. Verweij, M.D., Ph.D., Department of Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. email: bverweij@umcutrecht.nl.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Bandyk DFTowne JBSchmitt DDSeabrook GRBergamini TM: Therapeutic options for acute thrombosed in situ saphenous-vein arterial bypass grafts. J Vasc Surg 11:6806871990

    • Search Google Scholar
    • Export Citation
  • 2

    Bergamini TMTowne JBBandyk DFSeabrook GRSchmitt DD: Experience with in situ saphenous-vein bypasses during 1981 to 1989: determinant factors of long-term patency. J Vasc Surg 13:1371491991

    • Search Google Scholar
    • Export Citation
  • 3

    Bremmer JPVerweij BHvan der Zwan AReinert MMBeck HJTulleken CA: Sutureless nonocclusive bypass surgery in combination with an expanded polytetrafluoroethylene graft. Laboratory investigation. J Neurosurg 107:119011972007

    • Search Google Scholar
    • Export Citation
  • 4

    Chesebro JHClements IPFuster VElveback LRSmith HCBardsley WT: A platelet-inhibitor-drug trial in coronary-artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency. N Engl J Med 307:73781982

    • Search Google Scholar
    • Export Citation
  • 5

    EC/IC Bypass Study Group: Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313:119112001985

    • Search Google Scholar
    • Export Citation
  • 6

    Grubb RL JrDerdeyn CPFritsch SMCarpenter DAYundt KDVideen TO: Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA 280:105510601998

    • Search Google Scholar
    • Export Citation
  • 7

    Gundry SRJones MIshihara TFerrans VJ: Optimal preparation techniques for human saphenous vein grafts. Surgery 88:7857941980

  • 8

    Hendrikse Jvan der Zwan ARamos LMvan Osch MJGolay XTulleken CA: Altered flow territories after extracranial-intracranial bypass surgery. Neurosurgery 57:4864942005

    • Search Google Scholar
    • Export Citation
  • 9

    Klijn CJKappelle LJTulleken CAvan Gijn J: Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors. Stroke 28:208420931997

    • Search Google Scholar
    • Export Citation
  • 10

    Langer DJVajkoczy P: ELANA: Excimer Laser-Assisted Nonocclusive Anastomosis for extracranial-to-intracranial and intracranial-to-intracranial bypass: a review. Skull Base 15:1912052005

    • Search Google Scholar
    • Export Citation
  • 11

    Liu JKKan PKarwande SVCouldwell WT: Conduits for cerebrovascular bypass and lessons learned from the cardiovascular experience. Neurosurg Focus 14:3E32003

    • Search Google Scholar
    • Export Citation
  • 12

    Mizumura SNakagawara JTakahashi MKumita SCho KNakajo H: Three-dimensional display in staging hemodynamic brain ischemia for JET study: objective evaluation using SEE analysis and 3D-SSP display. Ann Nucl Med 18:13212004

    • Search Google Scholar
    • Export Citation
  • 13

    Ogasawara KOgawa A: [JET study (Japanese EC-IC Bypass Trial).]. Nippon Rinsho 64:Suppl 75245272006. (Jpn)

  • 14

    Okada YShima TNishida MYamane K: Retroauricular subcutaneous Dacron tunnel for extracranial-intracranial autologous vein bypass graft. Technical note. J Neurosurg 81:8008021994

    • Search Google Scholar
    • Export Citation
  • 15

    Patrono C: Aspirin as an antiplatelet drug. N Engl J Med 330:128712941994

  • 16

    Regli LPiepgras DGHansen KK: Late patency of long saphenous vein bypass grafts to the anterior and posterior cerebral circulation. J Neurosurg 83:8068111995

    • Search Google Scholar
    • Export Citation
  • 17

    Sekhar LNBucur SDBank WOWright DC: Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: evolution of surgical treatment and improved graft results. Neurosurgery 44:120712231999

    • Search Google Scholar
    • Export Citation
  • 18

    Sekhar LNKalavakonda C: Cerebral revascularization for aneurysms and tumors. Neurosurgery 50:3213312002

  • 19

    Seldinger SI: Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiol 39:3683761953

  • 20

    Sundt TM JrPiepgras DGMarsh WRFode NC: Saphenous vein bypass grafts for giant aneurysms and intracranial occlusive disease. J Neurosurg 65:4394501986

    • Search Google Scholar
    • Export Citation
  • 21

    Sundt TM IIISundt TM Jr: Principles of preparation of vein bypass grafts to maximize patency. J Neurosurg 66:1721801987

  • 22

    Tulleken CAVerdaasdonk RMBeck RJMali WP: The modified excimer laser-assisted high-flow bypass operation. Surg Neurol 46:4244291996

    • Search Google Scholar
    • Export Citation
  • 23

    Tulleken CAVerdaasdonk RMBerendsen WMali WP: Use of the excimer laser in high-flow bypass surgery of the brain. J Neurosurg 78:4774801993

    • Search Google Scholar
    • Export Citation
  • 24

    van Rooij WJSluzewski MSlob MJRinkel GJ: Predictive value of angiographic testing for tolerance to therapeutic occlusion of the carotid artery. AJNR Am J Neuroradiol 26:1751782005

    • Search Google Scholar
    • Export Citation
  • 25

    Woitzik JHorn PVajkoczy PSchmiedek P: Intraoperative control of extracranial-intracranial bypass patency by nearinfrared indocyanine green videoangiography. J Neurosurg 102:6926982005

    • Search Google Scholar
    • Export Citation
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