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Artery Relocation Reduces Stroke Risk in Atherosclerosis Patients

By HospiMedica International staff writers
Posted on 29 Oct 2018
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Image: EDAS surgery reroutes scalp arteries to provide new pathways for brain circulation (white arrows) (Photo courtesy of Cedars-Sinai).
Image: EDAS surgery reroutes scalp arteries to provide new pathways for brain circulation (white arrows) (Photo courtesy of Cedars-Sinai).
A new surgical technique can significantly decrease mortality and stroke recurrence in patients with severe atherosclerosis of brain arteries, according to a new study.

Researchers at Cedars-Sinai Medical Center (CSMC; Los Angeles, CA, USA) conducted a phase 2a clinical trial of a new surgical technique called encephaloduroarteriosynangiosis (EDAS), which involves re-routing arteries from the scalp and the membranes covering the brain and relocating them near cerebral areas at risk of stroke. Over time, angiogenesis creates fresh pathways for blood and oxygen to reach the brain. The study involved 52 patients with intracranial atherosclerotic disease (ICAD) with symptoms of either a recent stroke or transient ischemic attack (TIA). In addition to EDAS, the patients underwent intensive medical management.

The results revealed that after one year, 9.6% of the patients treated with EDAS experienced another ischemic stroke or died, compared with 21.2% of patients in a matched control group who received only intensive medical management involving diet and lifestyle changes and medications that included blood thinners, antihypertensives, and statins. Two EDAS patients required additional surgical interventions, but there were no intracranial hemorrhages or other serious adverse events. The study was presented at the World Stroke Congress, held during October 2018 in Montreal (Canada).

“Previously, EDAS has been used for moyamoya disease, a rare cerebrovascular disorder that affects younger patients. Our findings in this intermediate-stage trial are promising for applying EDAS surgery to intracranial atherosclerotic disease,” said lead author professor of neurosurgery Nestor Gonzalez, MD, director of the Cedars-Sinai Neurovascular Laboratory. “Even under the best current treatments, ICAD carries high rates of recurrent stroke and death, compared with other causes of stroke. Developing new therapeutic strategies is crucial for ICAD patients.”

ICAD of the major arteries (intracranial internal carotid artery, middle cerebral artery, vertebral artery, and basilar artery) is the most common proximate mechanism of ischemic stroke worldwide, causes 30-50% of strokes in Asians and 8-10% of strokes in Caucasians. Little is known about measures for primary prevention of the disease; in terms of secondary prevention of stroke due to ICAD, aspirin continues to be the preferred antiplatelet agent, along with clopidogrel. Aggressive risk factor management, either alone and in combination with dual antiplatelets, has been shown to be the most effective treatment.

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