title: Cerebral Revascularization for Aneurysms in the Flow-Diverter Era.
abstract: BACKGROUND
  Cerebral bypass has been an important tool in the treatment of complex intracranial aneurysms. The recent advent of flow-diverting stents (FDS) has expanded the capacity for endovascular arterial reconstruction.
  
  
  OBJECTIVE
  We investigated how the advent of FDS has impacted the application and outcomes of cerebral bypass in the treatment of intracranial aneurysms.
  
  
  METHODS
  We reviewed a consecutive series of cerebral bypasses during aneurysm surgery over the course of 10 years. FDS were in active use during the last 5 years of this series. We compared the clinical characteristics, surgical technique, and outcomes of patients who required cerebral bypass for aneurysm treatment during the preflow diversion era (PreFD) with those of the postflow diversion era (PostFD).
  
  
  RESULTS
  We treated 1061 aneurysms in the PreFD era (from July 2005 through June 2010) and 1348 in the PostFD era (from July 2010 through June 2015). Eighty-five PreFD patients (8%) and 45 PostFD patients (3%) were treated with cerebral bypass. PreFD patients had better baseline functional status compared to PostFD patients with average preoperative modified Rankin Scale score of 0.55 in PreFD and 1.18 in PostFD.
  
  
  CONCLUSIONS
  After the introduction of FDS, cerebral bypass was performed in a lower proportion of patients with aneurysms. Patients selected for bypass in the flow-diverter era had worse preoperative modified Rankin Scale scores indicating a greater complexity of the patients. Cerebral bypass in well-selected patients and revascularization remains an important technique in vascular neurosurgery. It is also useful as a rescue technique after failed FDS treatment of aneurysms.
authors.affiliation: Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington.
authors.forename: David C
authors.initials: DC
authors.lastname: Straus
authors.affiliation: Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington.
authors.forename: Harley
authors.initials: H
authors.lastname: Brito da Silva
authors.affiliation: Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington.
authors.forename: Lynn
authors.initials: L
authors.lastname: McGrath
authors.affiliation: Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington.|Department of Radiology, University of Washington-Harborview Medical Center, Seattle, Washington.|Department of Mechanical Engineering, University of Washington, Seattle, Washington.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Levitt
authors.affiliation: Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington.|Department of Radiology, University of Washington-Harborview Medical Center, Seattle, Washington.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Kim
authors.affiliation: Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington.|Department of Radiology, University of Washington-Harborview Medical Center, Seattle, Washington.
authors.forename: Basavaraj V
authors.initials: BV
authors.lastname: Ghodke
authors.affiliation: Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Barber
authors.affiliation: Department of Neurological Surgery, University of Washington-Harborview Medical Center, Seattle, Washington.|Department of Radiology, University of Washington-Harborview Medical Center, Seattle, Washington.
authors.forename: Laligam N
authors.initials: LN
authors.lastname: Sekhar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002548:Cerebral Revascularization / Q000379:methods* / Q000639:trends; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000639:trends; D012189:Retrospective Studies; D015607:Stents / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bypass; Cerebral aneurysm; Flow-diverter; Pipeline; Revascularization