Assessment of extracranial-intracranial bypass patency with 64-slice multidetector computerized tomography angiography.
BACKGROUND
Extracranial-intracranial (EC/IC) bypass is a useful procedure for the treatment of cerebral vascular insufficiency or complex aneurysms. We explored the role of multidetector computed tomography angiography (MDCTA), instead of digital subtraction angiography (DSA), for the postoperative assessment of EC/IC bypass patency.


METHODS
We retrospectively analyzed a consecutive series of 21 MDCTAs from 17 patients that underwent 25 direct or indirect EC/IC bypass procedures between April 2003 and November 2007. Conventional DSA was available for comparison in 13 cases. MDCTA used a 64-slice MDCT scanner (Aquilion 64, Toshiba). The proximal and distal patencies were analyzed independently on MDCTA and DSA by a neuroradiologist and a neurosurgeon. The bypass was considered patent when the entire donor vessel was opacified without discontinuity from proximal to distal ends and was visibly in contact with the recipient vessel.


RESULTS
MDCTA depicted the patency status in every patient. Bypasses were patent in 22 cases, stenosed in one, and occluded in two. DSA always confirmed the results of the MDCTA (sensitivity = 100%, 95% CI = 0.655-1.0; specificity 100%, 95% CI = 0.05-1.0).


CONCLUSIONS
MDCTA is a non-invasive and accurate exam to assess the postoperative EC/IC bypass patency and is a promising technique in routine follow-up.
Thines
Laurent
L
Department of Neurosurgery, Lille University Hospital, Lille, France.
Agid
Ronit
R
Dehdashti
Amir R
AR
da Costa
Leodante
L
Wallace
M Christopher
MC
Terbrugge
Karel G
KG
Tymianski
Michael
M
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods*; D002548:Cerebral Revascularization; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult