title: Revascularization and aneurysm surgery: techniques, indications, and outcomes in the endovascular era.
abstract: BACKGROUND
  Given advances in endovascular technique, the indications for revascularization in aneurysm surgery have declined.
  
  
  OBJECTIVE
  We sought to define indications, outline technical strategies, and evaluate the outcomes of patients treated with bypass in the endovascular era.
  
  
  METHODS
  We retrospectively reviewed all aneurysms treated between September 2006 and February 2013.
  
  
  RESULTS
  We identified 54 consecutive patients (16 males and 39 females) with 56 aneurysms. Aneurysms were located along the cervical internal carotid artery (ICA) (n = 1), petrous/cavernous ICA (n = 1), cavernous ICA (n = 16), supraclinoid ICA (n = 7), posterior communicating artery (n = 2), anterior cerebral artery (n = 4), middle cerebral artery (MCA) (n = 13), posterior cerebral artery (PCA) (n = 3), posterior inferior cerebellar artery (n = 4), and vertebrobasilar arteries (n = 5). Revascularization was performed with superficial temporal artery (STA) to MCA bypass (n = 25), STA to superior cerebellar artery (SCA) (n = 3), STA to PCA (n = 1), STA-SCA/STA-PCA (n = 1), occipital artery (OA) to PCA (n = 2), external carotid artery/ICA to MCA (n = 15), OA to MCA (n = 1), OA to posterior inferior cerebellar artery (n = 1), and in situ bypasses (n = 8). At a mean clinical follow-up of 18.5 months, 45 patients (81.8%) had a good outcome (Glasgow Outcome Scale 4 or 5). There were 7 cases of mortality (12.7%) and an additional 9 cases of morbidity (15.8%). At a mean angiographic follow-up of 17.8 months, 14 bypasses were occluded. Excluding the 7 cases of mortality, the majority of aneurysms (n = 42) were obliterated. We identified 7 cases of residual aneurysm and recurrence in 6 patients at follow-up.
  
  
  CONCLUSIONS
  Given current limitations with existing treatments, cerebral revascularization remains an essential technique for aneurysm surgery.
authors: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors: M Yashar S
authors: MY
authors: Kalani
authors: Wyatt
authors: W
authors: Ramey
authors: Felipe C
authors: FC
authors: Albuquerque
authors: Cameron G
authors: CG
authors: McDougall
authors: Peter
authors: P
authors: Nakaji
authors: Joseph M
authors: JM
authors: Zabramski
authors: Robert F
authors: RF
authors: Spetzler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery; D002548:Cerebral Revascularization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D020769:Posterior Cerebral Artery / Q000601:surgery; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000517:prevention & control; D013699:Temporal Arteries / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult