1228. Surgical Treatment and Long Term Outcomes of Adult Patients with Atherosclerotic Disease

Authors: Justin Lee Sim; Anadjeet Khahera; Evangeline Reyes-Pastorella; Brandon Christophe; E. Connolly, MD (New York, NY)

Introduction:

Superficial temporal artery to middle cerebral artery (STAMCA) is a direct revascularization surgery demonstrated to improve cerebral blood flow anomalies.  Encephaloduroarteriosynangiosis (EDAS) is an indirect revascularization surgery aimed to develop anastomosis over 3-18 months.  Both surgeries treat intracerebral atherosclerotic disease (IAD).  Our study examines whether STAMCA or EDAS leads to better functional outcomes in patients with symptomatic IAD.

Methods:

50 adult IAD patients (mean 57, range 29-77) were treated with STAMCA (36) or EDAS (14) from 1997-2018 at Columbia University Medical Center. Follow-up was obtained in person or telephone interview. Patients were evaluated for Glasgow Outcome Scale (GOS) at discharge, 1 month, 3 months, and 12 months post-discharge through retrospective chart review or follow-up phone call.

Results:

The majority of patients were male (60%), Caucasian (72%), and presented with ischemic symptoms (66%).  There was a statistically significant increase in GOS score from discharge (GOS=3.21±0.14, p=0.02), 1 month (GOS=3.27±0.15, p=0.04) and 3 months (GOS=3.62±0.21, p=0.04) when compared to 12 months (GOS=4.20±0.29) post-discharge for STAMCA.  There was a statistically significant increase in GOS scores from discharge (GOS=3.36±0.15) to 12 months (GOS=4.17±0.40, p=0.04) for EDAS. Post-operatively STAMCA patients experienced 6 ischemic (17%) and 2 hemorrhagic (3%) events.  EDAS patients experienced 3 ischemic (21%) and 2 hemorrhagic (14%) events.  

Conclusion:

Both STAMCA and EDAS were correlated with statistically significant improved outcomes at 12 months post-discharge.  STAMCA offered a more gradual improvement compared to EDAS.  This phenomenon may be attributable to the timing of reperfusion of the respective techniques.  STAMCA offers more immediate reperfusion after surgery, while EDAS can take months to form anastomosis.  While both surgeries lead to improved outcomes, STAMCA is able to do so at a faster pace than EDAS and with fewer complications in patients with symptomatic IAD.