Cerebrovascular bypass surgery

Cerebrovascular bypass surgery, also known as a cerebral artery bypass, is a surgical technique that restores blood flow to the brain. This procedure is recommended when there’s a blockage or narrowing in the blood vessels that supply oxygen and nutrients to the brain. Just like how a coronary bypass renews blood flow to the heart, cerebral artery bypass surgery ensures proper blood flow to the brain.

During cerebral artery bypass surgery, a blood vessel taken from outside the brain, called the donor blood vessel, is connected to one inside, rerouting blood flow around a damaged or blocked artery. This reinstates the blood supply to the brain and helps to reduce the risk of stroke. By constructing a new pathway around blocked or narrowed arteries, this procedure relieves cerebrovascular disease symptoms, prevents further neurological damage, and improves overall brain function and quality of life.

Cerebral artery bypass surgery is considered a complex procedure and is typically performed by neurosurgeons with specialized training in cerebrovascular disorders. Neurologists at Penn Medicine are among the leading neurology providers in the southeastern Pennsylvania and South Jersey region who are experts in performing these types of surgeries and providing specialized follow-up care and support.

There are two types of cerebral artery bypass surgeries: direct and indirect revascularization. 

• Direct revascularization, referred to as an STA-MCA bypass, is the most common type of bypass. It involves connecting the artery that sends blood to your scalp and face, called the superficial temporal artery (STA), to a major artery that supplies blood to your brain, called a middle cerebral artery (MCA). This procedure improves blood flow by enlarging the scalp artery and increasing blood circulation.
• Indirect revascularization is typically used to treat moyamoya disease, a rare condition where the arteries at the base of the brain narrow or get blocked over time. During this procedure, the surgeon moves a blood vessel, usually from the scalp, to the surface of the brain. This leads to the growth of new blood vessels in the brain. 

When preparing for cerebral artery bypass surgery, our doctors carefully consider the surgical technique that gives you the best possible outcome. The specific surgical approach used will depend on factors such as the location of the blood vessels, severity of the blockage, and your overall health. Using the latest technologies and up-to-date surgical approaches, we’re dedicated to relieving your symptoms and improving your well-being.

Your Penn Medicine provider may recommend cerebral artery bypass surgery if you've experienced the following: 

• An aneurysm, tumor, or buildup of plaque in the arteries that doesn't respond to other treatments
• Imaging tests that reveal narrowed or blocked arteries
• Medications that don’t effectively manage symptoms of stroke or transient ischemic attacks (TIAs)

Before undergoing cerebral artery bypass surgery, patients are evaluated to determine the most appropriate course of treatment. The decision to proceed with bypass surgery is made collaboratively between you, your family, and a team of Penn Medicine experts. Your doctor will explain how the procedure is done and give you time to ask questions. Your care team will review your medications with you, discuss your health history, and let you know how to prepare for surgery.

On the day of the procedure, you can expect the following:  

• Your surgery will be done at a hospital or surgery center.
• You’ll have anesthesia with sedation, so you’re asleep and pain-free during surgery. Your care team will monitor you the entire time to ensure your safety.
• Your surgeon will carefully make an incision in your skin and create a small hole in your skull to expose the affected blood vessels.
• Using microsurgical techniques and specialized instruments, your surgeon will graft a healthy blood vessel onto the affected area.
• Your surgeon will then create a new pathway for blood to flow by connecting the healthy blood vessel graft to the appropriate blood vessels in the brain, bypassing any blocked or narrowed sections.
• Once the bypass is established and blood flow is restored, your surgeon will carefully close the affected area using sutures or staples.
• The surgery takes about three hours.
• After the surgery, you’ll be monitored closely as you wake up from anesthesia. Most patients are discharged from the hospital after a couple of days.
• You may experience some discomfort or pain at the surgical site, which can be managed with medication prescribed by your doctor. 

We understand that surgery can sometimes feel overwhelming. Your Penn Medicine care team is by your side to support you. We’re dedicated to guiding you through every phase of your medical journey to make sure you get the highest care every step of the way. 

Most patients have minimal restrictions after cerebral artery bypass surgery. For example, until your first follow-up appointment: 

• Rest as much as possible.
• Avoid strenuous activities, alcohol, and nicotine products.
• Don’t board an airplane, drive, or return to work.
• Don’t lift anything heavier than five pounds. 

Our care team will provide you with detailed instructions to improve your recovery. It's important to comply with your provider's recommendations and attend follow-up appointments to monitor your progress and address any concerns during the healing process.