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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 499-506
DOI: 10.4103/ajns.AJNS_84_20
Original Article

EC-IC Bypass; Our experience of cerebral revascularization with intraoperative Dual-Image Video Angiography (Diva)

Girish Joshi
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
2   Department of Neurosurgery, Apollo Specialty Hospital, Bengaluru, Karnataka, India
,
Yasuhiro Yamada
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
,
Binoy Thavara
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
3   Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
,
Riki Tanaka
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
,
Kyosuke Miyatini
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
,
Kazutaka Nakao
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
,
Tsukasa Kawase
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
,
Katsumi Takizava
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
,
Yoko Kato
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
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Background: Extracranial-intracranial (EC-IC) arterial bypass has been used in the treatment of various cerebrovascular ischemic disease due to atherosclerosis or Moyamoya disease, skull base tumors encasing large IC artery or complex IC aneurysms. Aim: The aim is to analyze surgical technique (EC-IC bypass) and its outcome with intraoperative use of dual image video angiography (DIVA) and Doppler ultrasound. Materials and Methods: We studied in this article a series of 23 patients operated in Banbuntane Hotokukai Hospital, Fujita Health University, for which a superficial temporal artery-middle cerebral artery anastomosis was done for steno-occlusive disease, giant IC aneurysm or Moyamoya disease. The study was conducted between 2018 and 2020. We used dual-image video angiography (DIVA) and Doppler ultrasound to assess the luminal patency of anastomosis during the procedure. Results: In this study, three patients presented with Moyamoya disease, 4 had aneurysm, whereas 16 patients presented with the vascular steno-occlusive disease. The patients were divided into three categories (steno-occlusive disease, Moyamoya, and flow replacement for giant aneurysm). Dual image video angiography, along with intraoperative Doppler, helped us in the assessment of luminal patency of the anastomosis. Conclusion: Hemodynamic recovery after cerebrovascular bypass brings about a better outcome in ischemic stroke. The result of surgery improves with proper selection of patients with hemodynamic impairment (in Stage 2). With various modalities such as intraoperative Doppler, DIVA (Dual-image Video Angiography) and improved surgical techniques may aid in the reduction of complications and improve clinical outcome.

Key-words:

Cerebrovascular bypass - cerebrovascular ischemia - dual image video angiography - intraoperative Doppler ultrasound

Financial support and sponsorship

Nil.




Publication History

Received: 26 March 2020

Accepted: 04 June 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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