Extracranial-intracranial bypass in the elderly

The symptoms and signs of cerebrovascular insufficiency occur more frequently in the elderly population. It has often been assumed that individuals over 65 years of age are poor surgical candidates and that, therefore, prophylactic procedures should be withheld. The author reviews his experience with 25 elderly patients who had evidence of cerebrovascular insufficiency and lesions that were inaccessible to standard extracranial vascular surgical techniques. In this series, there were no deaths and there was only one neurological complication, which was a hypertensive hematoma that occurred during the immediate postoperative period. The only patient whose postoperative hospitalization was longer than 7 days was the individual who had the intracerebral hematoma. All patients with surgical temporal-middle cerebral artery anastomoses underwent angiography immediately after operation, and all of these bypass grafts were found to be patent. Extracranial-intracranial bypass grafting seems to be well-tolerated by elderly individuals, with minimal morbidity and mortality.