A modified encephalo-duro-synagiosis technique induced neovascularization in symptomatic atherosclerotic carotid artery occlusion: A Phase 1 trial.

A modified encephalo-duro-synagiosis technique induced neovascularization in symptomatic atherosclerotic carotid artery occlusion: A Phase 1 trial.

World Neurosurg. 2019 Jan 04;:

Authors: Volovici V, van Dijk EJ, van der Lugt A, Koudstaal PJ, Vincent AJ

Abstract
OBJECTIVE: This is the first study to assess safety and feasibility of a modified encephalo-galeo-duro-synangiosis operation in patients with atherosclerotic carotid artery occlusion.
METHODS: Eight patients who experienced new ipsilateral cerebrovascular events after diagnosis of carotid artery occlusion were recruited. To facilitate extra-to-intracranial collateralization five or six burr holes were made and the dura mater and arachnoid were opened. Patients were closely monitored for complications and underwent conventional angiography, MRI and perfusion-weighted MRI at baseline and one year follow-up. After 10 years, patients who were still alive were interviewed and assessed for functional outcome and neurological status.
RESULTS: No surgery-related adverse events were observed apart from temporary headache and subcutaneous effusion. Four of six patients developed extra-to-intracranial collateral blood vessels on angiography and these patients had no incident ischemic events during follow-up. During long-term follow-up (10 years), 3 patients had died. Of those living, 4 of the 5 patients reported total resolution of symptoms with no incidental ischemic events, while one patient still experienced disability from an ischemic stroke that occurred as a result of 1-year follow-up angiography.
CONCLUSION: Encephalo-duro-galeo-synangiosis in symptomatic carotid occlusion seems to be safe and feasible and may be able to induce extra-to-intracranial collaterals in patients with carotid artery occlusion. Further studies are needed to define the optimal therapeutic window and yield of burr hole surgery in treatment of symptomatic carotid occlusive disease as an adjuvant to extracranial -intracranial bypass.

PMID: 30615994 [PubMed - as supplied by publisher]

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