EDAS for Adult Intracranial Arterial Steno-Occlusive Disease. Long-Term Single Center Experience With 107 Operations
- Author(s): Gonzalez, Nestor Raul
- Advisor(s): Elashoff, Robert;
- Saver, Jeffrey
- et al.
Object: Encephaloduroarteriosynangiosis (EDAS) is a form of revascularization that has shown promising early results in the treatment of adult patients with moyamoya disease (MMD) and more recently in patients with intracranial atherosclerotic arterial steno-occlusive disease (ICASD). Herein we present the long-term results of a single-center experience with EDAS for adult MMD and ICASD.
Methods: Patients with ischemic symptoms despite intensive medical therapy were considered for EDAS. All patients undergoing EDAS were included. Clinical data from a retrospective dataset and a prospective cohort were collected, including recurrence of TIA and/or stroke, functional status, and death. Perren revascularization and ASITN collateral grades were recorded from angiograms.
Results: 107 EDAS were performed in 82 adults, 36 ICASD & 46 MMD. During a median follow-up of 22 months, 2 (2.4%) patients had strokes, only in the ICASD group. The probability of stroke-free survival at 2 years in the ICASD group was 94.3% (95%CI 80-98.6%). There were no strokes in the MMD group. The probability of TIA-free survival at 2 years was 89.4% (95%CI 74.7-96%) in ICASD and 99.7% (95%CI 87.5-99.9%) in MMD. There were no hemorrhages or stroke-related deaths. Angiograms in 85.7% of ICASD and 92% of MMD patients demonstrated Perren grade 3 and improvement in ASITN grade in all cases.
Conclusions: EDAS is well tolerated in adults with MMD and ICASD and improves collateral circulation to territories at risk. The rates of stroke after EDAS are lower than those reported with other treatments, including intensive medical therapy in patients with ICASD.