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Excimer laser–assisted nonocclusive anastomosis

An emerging technology for use in the creation of intracranial–intracranial and extracranial–intracranial cerebral bypass

David J. Langer, Albert Van Der Zwan, Peter Vajkoczy, Leena Kivipelto, Tristan P. Van Doormaal and Cornelis A. F. Tulleken

Excimer laser–assisted nonocclusive anastomosis (ELANA) has been developed over the past 14 years for assistance in the creation of intracranial bypasses. The ELANA technique allows the creation of intracranial–intracranial and extracranial–intracranial bypasses without the need for temporary occlusion of the recipient artery, avoiding the inherent risk associated with occlusion time. In this review the authors discuss the technique and its indications, while reviewing the clinical results of the procedure. The technique itself is explained using cartoon drawings and intraoperative photographs. Advantages and disadvantages of the technique are also discussed.