Purpose: Extra-intracranial (EC/IC) arterial bypass surgery is an important adjunct in the treatment of chronic cerebral ischemia, in the management of complex cerebral aneurysms and skull base tumours. The assessment of bypass patency in the early postoperative period is mandatory for patient management. So far, this requires digital subtraction angiographic studies (DSA), which carry a 1% risk of neurological complications. The ability of helical CT-angiography (CTA) to assess bypass patency, as less invasive imaging modality was investigated in the present study
Methods and Materials: Fourteen patients (9 male; 5 female; age (mean+/-sd) 46+/-12 yrs.) with symptomatic steno-occlusive cerebrovascular disease and hemodynamic compromise underwent standard EC/IC bypass procedure ("low-flow" bypass - A. temporalis superficialis - A. cerebri media anastomosis) via a temporal osteoclastic craniotomy. Bypass patency was studied with CTA between day 1 and 9 (mean: 3+/-2 days) and DSA between day 3 and 14 (mean: 7+/- 4 days) after surgery. Bypass patency in CTA was evaluated using overlapping 1.25mm source images and 3D-volume rendering analysis
Results: DSA showed a patent bypass in 13/14 (93 %) studies. CTA demonstrated a sufficient EC/IC anastomosis in 12/14 (86 %) investigations. The sensitivity and specificity of CTA in comparison to DSA were 92% and 100%, respectively. No procedure related complication was observed.
Conclusion: Our preliminary results suggest, that helical CTA permits the non-invasive assessment of EC/IC bypass patency in the early postoperative course.
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