Artikel
Experience with the ELANA non occlusive bypass technique for high-flow revascularizatrion in 56 patients
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Veröffentlicht: | 16. September 2010 |
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Objective: To present the surgical experience of two national bypass centers in Germany and Finland using the Excimer Laser Assisted Nonocclusive Anastomosis (ELANA) technique in the treatment of complex intracranial lesions via revascularization strategies.
Methods: Between 2002 and 2007, 56 consecutive patients (Germany 37, Helsinki 27) were elected for high-flow bypass surgery using the ELANA technique. In these 56 patients, a total of 59 ELANA bypass procedures was intended (intent-to-treat population). Surgical outcome (modified Rankin Scale), bypass patency rate and the success rate of the laser arteriotomy were assessed.
Results: 52 ELANA procedures within the intent-to-treat population of 59 surgeries (88%), could be successfully completed. Angiographic assessment on days 7–9 revealed a short-term patency rate of 96%. A favorable outcome (mRS) was achieved in 35/42 (84%) patients with anterior circulation aneurysm, 3/8 (37%) patients with posterior circulation aneurysms, 4/4 (100%) patients treated for acute ischemia, and 2/2 (100%) patients receiving a bypass prior to tumor removal. 30-days permanent morbidity and mortality rates were 9% and 13%, respectively.
Conclusions: The ELANA procedure requires a meticulous and careful operative technique. Morbidity and mortality rates are comparable to contemporary series of conventional high-flow revascularization strategies and remain considerable despite the non-occlusive nature of the ELANA technique. Nevertheless, our results clearly compare favorable with the natural histories of these patholgies as well as the results of published microsurgical and endovascular series.