Excimer laser-assisted non-occlusive cerebral vascular Anastomosis (ELANA): Review of the first UK experience

Abstract

The Excimer Laser Assisted Non-occlusive cerebral vascular Anastomosis (ELANA) has been proposed as a major advance in the field of cerebral revascularisation. Appreciable challenges remain, however. We report our experience with introducing this technique to the UK and review the field of cerebral revascularisation and flow replacement.

Retrospective review of prospectively recorded case series. Data were collected prospectively, complication data were recorded and analyzed and functional surgical outcomes were measured using the modified Rankin scale (MRS). Ten patients, during a 2-year period, were considered suitable for high-flow cerebrovascular bypass surgery, with 8 proceeding to surgery. Seven bypasses were completed and 1 abandoned. Of the 5 patients neurologically intact preoperatively, 3 remained so postoperatively, 4 experienced no neurological deficit and one suffered transient hemiparesis due to hyperperfusion which resolved. One patient with preoperative hemiparesis improved. One patient died 8 days postoperatively. Overall long-term patency rate was (42%), however 3 thrombosed bypasses were all competitive (used for prophylactic intraoperative reasons), 2 thrombosing after the surgical procedure was completed. We discuss the role for this modern technique and the lessons learnt from its introduction to the UK, and consider the current and future requirements for cerebral revascularisation.

Key words:

• Stroke
• neurosurgery
• subarachnoid haemorrhage
• cerebrovascular
• disease
• vascular surgery
• vascular bypass
• non-occlusive

Acknowledgements

We are indebted to Professor C Tulleken, emeritus professor of the department of Neurosurgery, Utrecht, for his guidance on the introduction of the ELANA technique into the UK.

Conflict of interest: No external sources of funding were received in respect of this work. The authors confirm they have no competing interests to declare. The authors confirm that they are jointly responsible for this work. Christos Tolias is the senior author and acts as guarantor.

Ethical approval: The introduction of the ELANA technique to King's College Hospital was reviewed and approved by the hospital Novel Procedures Board.