Clinical Research
Revascularization experience and results in ischaemic cerebrovascular disease: Moyamoya disease and carotid occlusion
Experiencia y resultados de las técnicas de revascularización en patología cerebral isquémica: enfermedad de moyamoya y oclusión carotídea
Fuat Arikana,b,
, Marta Rubierac, Joaquín Serenad, Ana Rodríguez-Hernándeza, Darío Gándaraa, Carles Lorenzo-Bosquete, Alejandro Tomasellof, Ivette Chocróng, Maximiliano Quintana-Corvalanh, Juan Sahuquilloa,b
Corresponding author
a Servicio de Neurocirugía, Hospital Universitario Vall d’Hebron, Barcelona, Spain
b Unidad de Investigación de Neurotraumatología-Neurocirugía (UNINN), Institut de Recerca Vall d’Hebron, Barcelona, Spain
c Servicio de Neurología, Hospital Universitario Vall d’Hebron, Barcelona, Spain
d Servicio de Neurología, Hospital Universitario Josep Trueta, Girona, Spain
e Servicio de Medicina Nuclear, Hospital Universitario Vall d’Hebron, Barcelona, Spain
f Unidad de Neurorradiología Intervencionista, Hospital Universitario Vall d’Hebron, Barcelona, Spain
g Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d’Hebron, Barcelona, Spain
h Servicio de Neurocirugía, HIGA San Martin, Ciudad de la Plata, Buenos Aires, Argentina
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Paciente mujer de 49<span class="elsevierStyleHsp" style=""></span>años de edad diagnosticada de enfermedad de moyamoya tras presentar un episodio brusco caracterizado por una paresia braquial izquierda. La RM cerebral (A) muestra signos de atrofia cerebral con múltiples lesiones isquémicas y a nivel de ganglios basales numerosos vacíos de señal correspondientes a las lenticuloestriadas dilatadas características. El estudio de reserva cerebral muestra una severa afectación de la perfusión de ambos hemisferios (B) que empeoran tras la administración de la acetazolamida (C), lo que indica que la paciente se encuentra en una situación de fallo hemodinámico (respuesta positiva al test de la acetazolamida). D y E muestran el estudio lateral y anteroposterior angiográfico de la carótida interna derecha, en la que se muestra la oclusión distal de la carótida sin llegarse a visualizar la cerebral media y cerebral anterior, asociada a la presencia de una red vascular anormal identificable durante la fase arterial correspondientes a las lenticuloestriadas dilatadas que le confieren el aspecto característico de la enfermedad de moyamoya. La formación de estas arterias colaterales da un patrón angiográfico muy característico denominado en la literatura anglosajona <span class="elsevierStyleItalic">puff of smoke</span>, por el que Suzuki y Takayu acuñaron el término moyamoya en 1969 (<span class="elsevierStyleItalic">puff of smoke</span> en japonés). En el estudio angiográfico se evidencian múltiples sinangiosis por vasos procedentes de la carótida externa. F)<span class="elsevierStyleHsp" style=""></span>Detalle quirúrgico de la realización de la anastomosis mediante una sutura de 10/0 entre la arteria temporal superficial y una rama cortical de la arteria cerebral media. G)<span class="elsevierStyleHsp" style=""></span>Videoangiografía intraoperatoria con verde de indocianina en la que se demuestra la correcta patencia de la anastomosis. Tras finalizar la anastomosis se procede a la realización de la revascularización indirecta. Para ello se sobrepone el músculo temporal y la duramadre evertida por debajo de los márgenes de la craneotomía para favorecer la formación de una encefaloduromiosinangiosis. En el control angioTC realizado tras el segundo tiempo quirúrgico (I) se demuestra la patencia de ambas anastomosis. K)<span class="elsevierStyleHsp" style=""></span>Control al año de la reserva vascular cerebral mediante la realización de un SPECT y tras la administración de acetazolamida. El SPECT basal (J), comparado con el preoperatorio (B), muestra una mejoría global en la perfusión de ambos hemisferios. Tras la administración de acetazolamida se muestra una mejoría en la perfusión cerebral, lo que indica que el paciente presenta una reserva vascular conservada (respuesta negativa al test de la acetazolamida).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fuat Arikan, Marta Rubiera, Joaquín Serena, Ana Rodríguez-Hernández, Darío Gándara, Carles Lorenzo-Bosquet, Alejandro Tomasello, Ivette Chocrón, Maximiliano Quintana-Corvalan, Juan Sahuquillo" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Fuat" "apellidos" => "Arikan" ] 1 => array:2 [ "nombre" => "Marta" "apellidos" => "Rubiera" ] 2 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Serena" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "Rodríguez-Hernández" ] 4 => array:2 [ "nombre" => "Darío" "apellidos" => "Gándara" ] 5 => array:2 [ "nombre" => "Carles" "apellidos" => "Lorenzo-Bosquet" ] 6 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Tomasello" ] 7 => array:2 [ "nombre" => "Ivette" "apellidos" => "Chocrón" ] 8 => array:2 [ "nombre" => "Maximiliano" "apellidos" => "Quintana-Corvalan" ] 9 => array:2 [ "nombre" => "Juan" "apellidos" => "Sahuquillo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529849618300133" "doi" => "10.1016/j.neucie.2018.01.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849618300133?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147318300216?idApp=UINPBA00004B" "url" => "/11301473/0000002900000004/v2_202209110518/S1130147318300216/v2_202209110518/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2529849618300224" "issn" => "25298496" "doi" => "10.1016/j.neucie.2018.02.003" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "325" "copyright" => "Sociedad Española de Neurocirugía" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Neurocirugia. 2018;29:187-200" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical research</span>" "titulo" => "Radiation protection measures: Implications on the design of neurosurgery operating rooms" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "187" "paginaFinal" => "200" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Medidas de protección radiológica: implicaciones en el diseño de quirófanos de neurocirugía" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2743 "Ancho" => 2500 "Tamanyo" => 285490 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Sketch of the radiation protection elements of the operating theatre following the remodelling: shielding and positioning of the screen. 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experience and results in ischaemic cerebrovascular disease: Moyamoya disease and carotid occlusion" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "170" "paginaFinal" => "186" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Fuat Arikan, Marta Rubiera, Joaquín Serena, Ana Rodríguez-Hernández, Darío Gándara, Carles Lorenzo-Bosquet, Alejandro Tomasello, Ivette Chocrón, Maximiliano Quintana-Corvalan, Juan Sahuquillo" "autores" => array:10 [ 0 => array:4 [ "nombre" => "Fuat" "apellidos" => "Arikan" "email" => array:1 [ 0 => "farikan@vhebron.net" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Marta" "apellidos" => "Rubiera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Joaquín" "apellidos" => "Serena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "Ana" "apellidos" => "Rodríguez-Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Darío" "apellidos" => "Gándara" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Carles" "apellidos" => "Lorenzo-Bosquet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 6 => array:3 [ "nombre" => "Alejandro" "apellidos" => "Tomasello" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 7 => array:3 [ "nombre" => "Ivette" "apellidos" => "Chocrón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] ] ] 8 => array:3 [ "nombre" => "Maximiliano" "apellidos" => "Quintana-Corvalan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] 9 => array:3 [ "nombre" => "Juan" "apellidos" => "Sahuquillo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Servicio de Neurocirugía, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Investigación de Neurotraumatología-Neurocirugía (UNINN), Institut de Recerca Vall d’Hebron, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Universitario Josep Trueta, Girona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Unidad de Neurorradiología Intervencionista, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Neurocirugía, HIGA San Martin, Ciudad de la Plata, Buenos Aires, Argentina" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Experiencia y resultados de las técnicas de revascularización en patología cerebral isquémica: enfermedad de moyamoya y oclusión carotídea" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1077 "Ancho" => 1417 "Tamanyo" => 254807 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Vascular reserve study performed on patient #6 in the occlusive ischaemic disease series. The preoperative study reveals decreased perfusion in the left hemisphere that worsened dramatically after administration of acetazolamide (positive response). In the follow-up study performed at one year, the patient did not present an improvement in the perfusion of the revascularized hemisphere, with a negative response in the acetazolamide test.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Since the first surgical clipping of a cerebral aneurysm by Walter Dandy in 1938, vascular neurosurgery has undergone significant scientific and technological advances. Without doubt, the advance that has had the greatest influence on vascular neurosurgery was the introduction by Guglielmi et al. in 1991 of endovascular treatment through the deployment of detachable platinum coils in the aneurysmal sac to achieve the exclusion of cerebral aneurysms.<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">1</span></a> Since then, endovascular treatment has advanced considerably, with the continual development of more and more devices, capable of treating greater numbers of patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This rapid development in endovascular treatment has undoubtedly changed the current profile of neurosurgical vascular patients, such that the patients who end up in neurosurgical operating rooms have become fewer but more complex. In the case of surgical treatment of aneurysms, it is now rare to need to operate on small aneurysms that are easily resolved with the application of a single clip, provided that there are no associated haematomas requiring evacuation. Nowadays, aneurysm surgery is much more complex, with most cases involving large or giant, thrombotic or calcified aneurysms, or those with branches arising directly from the aneurysmal sac or located in areas that are difficult to access both endovascularly and neurosurgically. Endovascular treatment has created a new profile of extremely complex patients, such as those who present partially embolised thrombotic aneurysms or who have stents, in whom it is necessary to construct one or more bypasses in order to exclude the aneurysm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The technical feats that vascular neurosurgery has performed in order to achieve positive outcomes in these highly complex patients would come to be used in other conditions, such as the use of revascularisation techniques in cerebral ischaemia.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In Spain, vascular neurosurgery has traditionally focused preferentially on haemorrhagic stroke and, within this subgroup, primarily on subarachnoid haemorrhage. However, neurosurgeons are playing an ever-increasing role in ischaemic stroke, whether due to the growing interest in endovascular techniques in vascular neurosurgery, the unquestionable results of decompressive craniectomy in malignant middle cerebral artery infarction, or the indisputable role of revascularisation techniques in moyamoya disease (spontaneous occlusion of the circle of Willis), and possible also thanks to their role in a subgroup of symptomatic patients with carotid occlusions and decreased cerebrovascular reserve.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The Carotid Occlusion Surgery Study (COSS) confirmed that severe deterioration in cerebral haemodynamics is a high-risk factor for recurrent ischaemic stroke due to poor collateral circulation in patients with complete occlusion of the internal carotid.<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">3</span></a> Nevertheless, it should be noted that, despite the high expectations this randomised, multicentre, prospective study created, it was suspended when the interim analysis found no differences between the surgical and medical groups. We must therefore recognise that, in spite of what has happened in moyamoya disease, where the indications for cerebral vascularisation are now indisputable, the current evidence reveals a confusing and contradictory perspective on the role of revascularisation surgery in cerebral ischaemia caused by occlusive disease. At our site, the publication of the COSS study forced us to reassess the indications for surgical treatment in patients with carotid occlusion. Only those patients with carotid occlusion and haemodynamic insufficiency confirmed in complementary examinations, who would continue to be symptomatic despite intensive medical treatment, are currently considered candidates for revascularisation surgery.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The objective of this study is to present the personal experience gained by the principal author of the paper and to analyse the results of revascularisation surgery in both moyamoya disease and occlusive cerebral ischaemia.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">Descriptive study of the neurosurgery department's prospective vascular disease database. Patients with moyamoya disease or moyamoya syndrome and patients with occlusive ischaemic disease who were treated neurosurgically by the principal author of the paper between October 2014 and September 2017 were analysed.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The demographic and clinical data analysed for the occlusive ischaemic disease series included age, gender, classic cardiovascular risk factors, symptoms motivating the surgical indication and the most prominent characteristics from the angiographic study, cerebral MRI and cerebral SPECT at baseline and after administration of acetazolamide.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the series of patients with moyamoya disease or moyamoya syndrome, the demographic data analysed included age and gender, and the clinical data included the form of presentation and the revascularisation procedures performed.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The clinical results for both series were quantitatively assessed using the modified Rankin Scale (mRS) in the preoperative period and at 6 months and one year from the intervention. For both series, cerebral haemodynamic status was analysed in the preoperative period and at one year from surgery, as well as the number and type of complications in both series.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Cerebral haemodynamic reserve study</span><p id="par0055" class="elsevierStylePara elsevierViewall">At our site, the technique of choice for the cerebral haemodynamic reserve (CHR) study is to perform a cerebral SPECT at baseline and after administering acetazolamide. The SPECT procedure used for the CHR study took place over 2 days, the first under baseline conditions and the second after administering 1<span class="elsevierStyleHsp" style=""></span>g of acetazolamide intravenously 15–20<span class="elsevierStyleHsp" style=""></span>min after administering the radiotracer. In terms of methodology (dose of tracer administered, acquisition and processing of images), both cerebral SPECT exams were performed with the same characteristics: in a sensory resting state, a dose of 25<span class="elsevierStyleHsp" style=""></span>mCi (925<span class="elsevierStyleHsp" style=""></span>MBq) of 99mTc-HMPAO (CERETEC™, GE Healthcare) was administered to the patient and after 20<span class="elsevierStyleHsp" style=""></span>min, tomographic images were acquired using a dual-headed gamma camera (Siemens e-cam), and high-resolution, low-energy parallel collimators, 360° acquisition, 1 image/30<span class="elsevierStyleHsp" style=""></span>s/3°, matrix 128<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>128. Reconstruction was performed using filtered back-projection with a Butterworth 7/0.3 filter, applying Chang's attenuation correction (coefficient 0.11). It should be noted that the intravenous form of acetazolamide is not currently commercially available in Spain and must be obtained as a foreign medicine for compassionate use.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In cases in which, due to clinical conditions, it was not possible to perform the CHR study using SPECT, the reserve was assessed using transcranial Doppler with the voluntary apnoea test.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Surgical protocol</span><p id="par0065" class="elsevierStylePara elsevierViewall">The patient received antiplatelet therapy (300<span class="elsevierStyleHsp" style=""></span>mg acetylsalicylic acid) prior to surgery. The path of the superficial temporal artery is identified using a Doppler probe. After preparing the field, a linear incision is made under microscopic visualisation, following the trajectory of the superficial temporal artery, exposing it between the zygomatic bone and the superior temporal line. The dura mater is carefully dissected from the bone selected for craniotomy and opened, attempting to preserve the middle meningeal artery intact, as it often provides critical collateral circulation in cerebral ischaemia.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Once the dura mater has been opened, the cortical artery with the largest lumen is identified; this artery will receive the anastomosis. The donor artery is then prepared and the arachnoid mater is opened to expose approximately 1.5–2<span class="elsevierStyleHsp" style=""></span>cm of the receptor artery. A terminal–lateral anastomosis is created between the superficial temporal artery and the M4 cortical segment of the middle cerebral artery (MCA) using size 10-0 monofilament sutures. For this step, two anchor points are created at each end, allowing a continuous suture to be used on each side, paying special attention to ensure that the faces of both intimas are overlaid correctly. The permeability of the anastomosis is assessed routinely using micro-Doppler and/or indocyanine green (ICG) video angiography. In the case of moyamoya disease, the dura mater is left open and the temporal muscle is laid on the exposed surface of the brain. The bone is replaced, taking care that the craniotomy margins do not compress the artery. If necessary, a small bone resection is performed to facilitate the adaptation of the artery (and temporal muscle in moyamoya disease).</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Occlusive ischaemic disease</span><p id="par0075" class="elsevierStylePara elsevierViewall">In the period from October 2014 to September 2017, 23 patients underwent revascularisation through the creation of an anastomosis between the superficial temporal artery and a cortical branch of the middle cerebral artery. The median age for the series presented is 61 years (min. 47, max. 79), with the male gender being predominant (17 men vs 6 women). The cardiovascular risk factors encountered most frequently were hypertension (95.6%) and smoking (78.3%). In all of the subjects, the reason for surgery was symptoms of haemodynamic failure (limb shaking, fluctuating deficits, etc.) or repeated strokes of haemodynamic origin in spite of medical treatment. In all cases, the motive was occlusion of the internal carotid artery, although 7 patients also had occlusion or stenosis of other vascular territories. The clinical and radiological characteristics of the series are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The CHR study was performed using cerebral SPECT at baseline and after administering acetazolamide; all patients on whom SPECT could be performed presented a decreased CHR. In five patients, haemodynamic failure could not be confirmed using cerebral SPECT due to the severity of their clinical condition, which necessitated priority surgery. In these cases, the decreased CHR was demonstrated using a cerebral vasomotor reactivity study, performing a transcranial Doppler study with a voluntary apnoea test.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Three complications arose in the series, all of them serious. Two patients presented intraparenchymal haemorrhage during the immediate postoperative period (first 24<span class="elsevierStyleHsp" style=""></span>h) and required urgent surgical reintervention. In one of these (patient #14), this complication led to new neurological deficits (hemiplegia and motor aphasia) with a poor outcome at the 6-month follow-up. As the patient came from another autonomous community, no clinical follow-up or CHR study at one year was conducted. The second patient who suffered a haemorrhagic complication (patient #21) also presented neurological deterioration (hemiparesis predominantly in the right leg and motor aphasia) secondary to a cerebral haemorrhage at 24-h from surgery. At the time of writing, this patient's one-year control is pending (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The third patient presented femoral artery thrombosis related to the postoperative angiographic study. This patient's clinical course was poor and eventually the limb had to be amputated; in spite of this, the patient eventually died due to sepsis.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The follow-up data that we obtained for all patients but one (patient #8) show a normalisation of the CHR in the study using SPECT at baseline and after administering acetazolamide (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). In that single patient (patient #8), the study shows no increase in cerebral perfusion after administering acetazolamide (positive response). However, despite continuing to have a decreased CHR, this patient presented an improvement with regard to the preoperative SPECT, in which, after administering acetazolamide, there was a severe reduction in perfusion, primarily in the right hemisphere. This patient remains completely asymptomatic and has presented no more ischaemic events after 27-months of follow-up.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">With the exception of the three patients with serious complications, all subjects presented a good neurological outcome without recurrences associated with the baseline ischaemia. Only one patient presented a new ischaemic stroke during the monitoring period, but in this case (patient #5) the stroke occurred in the territory of the contralateral middle cerebral artery after occlusion of the internal carotid. Lastly, one patient died 26 months after the revascularisation surgery due to the rupture of an aneurysm located at the bifurcation of the contralateral middle cerebral artery. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the clinical and haemodynamic outcomes of the series of patients with occlusive ischaemic disease.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Moyamoya disease</span><p id="par0100" class="elsevierStylePara elsevierViewall">In the period from October 2014 to September 2017, 25 patients received neurosurgical treatment (<a class="elsevierStyleCrossRefs" href="#tbl0015">Tables 3 and 4</a>). The median age for the series was 40 years (min. 3, max. 68), with the female gender being predominant (14 female vs 11 male). Five patients were diagnosed and treated at paediatric age. Twenty patients presented moyamoya disease, of whom only two patients had a haemorrhagic onset, while five patients presented moyamoya syndrome with unilateral involvement. All of the paediatric cases had an ischaemic onset (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Two patients in the series were related (mother #24 and daughter #16).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The diagnostic tests performed on these patients included a cerebrovascular CHR study using SPECT at baseline and after administering acetazolamide. The CHR study revealed haemodynamic compromise in all patients. It should be noted that this CHR study was not performed on three of the youngest paediatric patients in view of the clinical and radiological evidence of the involvement of their disease and in order to keep the dose of ionising radiation absorbed to a minimum. Revascularisation was scheduled for all patients using a combination of direct techniques (anastomosis between the superficial temporal artery and a cortical branch of the middle cerebral artery) and indirect techniques (encephaloduromyosynangiosis). In patients with moyamoya syndrome, revascularisation was only performed in the affected hemisphere. In the case of patients with moyamoya disease, cerebral revascularisation of both hemispheres was planned in two separate surgical procedures approximately one month apart and beginning with the most haemodynamically affected side. At the time of writing, two patients in our series are still awaiting their second surgical revascularisation. Direct cerebral revascularisation could not be carried out on three occasions due to the absence of a receptor artery of sufficient lumen to be able to create an anastomosis.</p><p id="par0110" class="elsevierStylePara elsevierViewall">With regard to outcomes (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>), the one-year cerebral SPECT, conducted on those patients who were eligible owing to their clinical course, revealed resolution of haemodynamic failure in all cases. Four patients presented postoperative complications. One patient presented an acute subdural haematoma that required urgent surgical evacuation. Two patients presented a subdural collection in the deferred tomographic control that required surgical evacuation with placement of a subdural drain. One patient presented wound dehiscence requiring surgical revision. Neurological outcomes were very satisfactory in all patients, with no neurological deterioration at 6- and 12-months follow-up, including in those who presented complications. <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a> shows an example from patient #13 in the series.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Revascularisation surgery is a very useful tool that is absolutely necessary today as part of the vascular neurosurgeon's arsenal.</p><p id="par0120" class="elsevierStylePara elsevierViewall">There are various options for cerebral revascularisation, depending essentially on the condition for which it is required. Traditionally, a bypass is classified based on the donor and receptor arteries, and may be extracranial–intracranial or intracranial–intracranial, with or without the use of a graft (arterial or venous).<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">4</span></a> The type (end-to-side, end-to-end or side-to-side) and number of microanastomoses also vary depending on the indications and specific angiographic anatomy of each patient. From a haemodynamic point of view, anastomoses are also classified by the flow provided by the bypass: low flow (<50<span class="elsevierStyleHsp" style=""></span>ml/min), medium flow (50–100<span class="elsevierStyleHsp" style=""></span>ml/min) or high flow (>100<span class="elsevierStyleHsp" style=""></span>ml/min).<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">4</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The choice of bypass depends on multiple factors, with low flow extracranial–intracranial bypass using end-to-side anastomosis between the superficial temporal artery and a cortical branch of the middle cerebral artery being the most used in ischaemic disease and moyamoya disease, since the additional flow it provides is sufficient to lift patients out of haemodynamic failure.<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">5</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The first bypass between the superficial temporal artery and a cortical branch of the middle cerebral artery was reported by Yasargil and Donaghy<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">6</span></a> in 1966, initially in a laboratory animal and one year later in a patient. Although microsurgical techniques have matured in the years since, the use of cerebral revascularisation using vascular microsurgical anastomosis had not spread to Spain, probably due to the high requirements needed to implement it and the small percentage of patients at each centre who might benefit from these techniques. However, thanks to the spread of endovascular treatment and to the reduced number and increased complexity of patients who are candidates for surgery, revascularisation techniques are becoming ever more necessary. In our opinion, in order to achieve competitive results, Spain would need a clear specialisation initiative, with a few high-volume centres specialising in the neurosurgical treatment of these patients.</p><p id="par0135" class="elsevierStylePara elsevierViewall">The results we present are drawn from the personal experience of the primary author of the paper in a centre with a clear subspecialty in vascular neurosurgery, which is integrated in a multidisciplinary team specialising in stroke, made up of neurologists, neurosurgeons and radiologists who are involved in the treatment of these patients. In relation to cerebral revascularisation, our hospital's neurosurgery department has always had a clear position with regard to this pathology, with a firm belief in specialisation in vascular neurosurgery, and has for years supported the implementation of revascularisation techniques, not only in vascular conditions but also in situations in which it is necessary to conserve flow, such as in skull base meningiomas with arterial compromise.</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Cerebral ischaemia caused by carotid artery occlusion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Stroke is a significant cause of death and disability in industrialised societies. The World Health Organisation (WHO) highlights that in Europe, half the years a person lives with disability are caused by neurological diseases.<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">7</span></a> The estimator used by the WHO, known as Disability Adjusted Life Years (DALY), is calculated from the number of years lost due to premature death and the years during which a patient survives with disability. DALY is a robust epidemiological variable, incorporates direct and indirect healthcare costs and can be used as a comparative estimator in different types of society. Currently, the WHO has determined that, after myocardial ischaemia, stroke is the second leading cause of lost DALY in Europe, estimating a progressive increase due to the gradual ageing of the population and improved stroke survival rates.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In Spain, its prevalence in the population over 65 years of age has been estimated between 4.6% and 8.5%, with an incidence in Europe of 101.1–239.3 per 100,000 in men and 63.0–158.7 per 100,000 in women in the year 2009.<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">8–10</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Complete occlusion of the internal carotid artery due to atherosclerotic disease is responsible for up to 25% of ischaemic strokes. Carotid artery occlusion is a clinical situation of particular significance due to the elevated risk of recurrent ischaemic stroke.<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">11–17</span></a> This recurrence, despite correct medical treatment, may be the most important factor from a neurosurgical point of view, as it gives rise to the possibility of implementing other treatments that might improve the prognosis for symptomatic patients with occlusive cerebrovascular disease and decreased CHR, including cerebral revascularisation techniques using vascular anastomosis.</p><p id="par0155" class="elsevierStylePara elsevierViewall">CHR is the residual capacity of the brain's circulation to be able to increase the cerebral blood flow volume under certain circumstances by increasing arteriolar dilation. CHR capacity depends on both the condition of the collateral circulation and of the microcirculation. CHR can be quantified by assessing the changes produced in cerebral blood flow in response to certain vasodilator stimuli. This is called cerebral vasomotor reactivity or cerebrovascular reactivity and can be measured using various methods, the most widely used being response to 5% CO<span class="elsevierStyleInf">2</span> inhalation and intravenous infusion of acetazolamide. The degree of haemodynamic involvement has been classified in two basic stages. The first refers to the period of self-regulating vasodilation that enables normal cerebral blood flow to be maintained through decreasing vascular resistance. The second stage is reached when maximum vasodilation (loss of CHR) is no longer sufficient to maintain cerebral blood flow in keeping with demands. In this stage, the brain is capable of compensating this deficit through greater oxygen extraction. Once maximum oxygen extraction is reached, drops in cerebral perfusion pressure (and consequently in cerebral blood flow) disrupt oxygen metabolism, leading to infarction.<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">18</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">This situation of increased oxygen extraction secondary to haemodynamic failure can be detected by performing a PET-OEF (Grubb, JAMA, 1988) using <span class="elsevierStyleSup">15</span>O<span class="elsevierStyleInf">2</span>.<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">19</span></a> However, due to the short half-life of this radionuclide, the absence of cyclotrons close to nuclear medicine centres and a series of other technical difficulties mean that diagnostic techniques using <span class="elsevierStyleSup">15</span>O<span class="elsevierStyleInf">2</span> are not used in Spain and are only used in a few centres worldwide, primarily for research purposes. For this reason, other diagnostic techniques have been described (xenon-CT, SPECT, transcranial Doppler and perfusion CT and MRI) that are designed to obtain information on cerebral perfusion status and the presence of these compensatory mechanisms using vasodilator stimuli (essentially hypercapnia or acetazolamide), quantifying the changes produced by the stimulation in cerebral blood flow, cerebral blood volume or the ratio between the two. Each technique has its advantages and disadvantages but they each offer information that allows patients with compromised cerebral haemodynamics to be identified. Although there are no studies that would allow us to compare the reliability of these diagnostic methods, all of them seek to detect loss of CHR. At our site, the technique of choice for the CHR study is performing a cerebral SPECT at baseline and after administering acetazolamide. Acetazolamide is a cerebral vasodilator that under normal conditions increases cerebral blood flow, but in haemodynamic failure, because the patient has already reached maximum vasodilation, cerebral blood flow does not increase and may even decrease as blood is ‘robbed’ by the healthy hemisphere.</p><p id="par0165" class="elsevierStylePara elsevierViewall">It is worth noting that the CHR study is indispensable in these patients since an anatomical diagnosis of carotid artery occlusion does not per se determine the haemodynamic situation in the brain. Thus, it has been demonstrated that patients in whom cerebral angiography shows seemingly good collateral circulation can present haemodynamic failure in CHR studies.<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">20–22</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Revascularisation surgery in cerebral ischaemia gained much popularity after the first reported description by Donaghy and Yasargil,<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">6</span></a> first being used in the 1980s in a number of diseases, such as the treatment of chronic occlusive cerebrovascular disease, skull base tumours, complex aneurysms, carotid-cavernous fistulas, acute cerebral ischaemia, cerebral vasospasm and moyamoya disease.</p><p id="par0175" class="elsevierStylePara elsevierViewall">The publication in 1985 of the negative results of the international study on the use of microsurgical revascularisation techniques for reduction of stroke risk in patients with occlusive cerebrovascular disease, together with the progressive development of endovascular techniques such as angioplasty or the insertion of stents, significantly limited the use of microsurgical revascularisation techniques in the treatment of cerebral ischaemia.<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">23</span></a> Regardless, the international study demonstrated that cerebral revascularisation techniques presented a high rate of patency (96%) with low surgical risk (30-day mortality of 0.6% and serious morbidity of 2.5%). Nevertheless, and in spite of the results of the international study, cerebral revascularisation techniques continued to be used primarily due to the numerous criticisms the study received.<a class="elsevierStyleCrossRefs" href="#bib0505"><span class="elsevierStyleSup">24–26</span></a> Incorrect patient screening, with a population that did not represent at-risk subjects and a lack of parameters to determine the cerebral haemodynamic situation constituted the main criticisms of the study.<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">25,27,28</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">These criticisms led to the conduct of the Carotid Occlusion Surgery Study (COSS),<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">29</span></a> which revived the use of revascularisation techniques in cerebral ischaemia in the very well-defined subgroup of patients with occlusive cerebrovascular disease and compromised CHR (defined in the COSS study by an increase in the oxygen extraction fraction measured using PET techniques). However, the results of the COSS study, published in 2013, were once again disheartening.<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">3</span></a> This study was also unable to show the possible benefits of revascularisation surgery in occlusive ischaemic disease.</p><p id="par0185" class="elsevierStylePara elsevierViewall">The COSS study is a well-designed study and its results cannot be ignored. On the one hand, we should note the high rates of patency of bypass surgery (98% at 30 days and 96% at 2 years), which demonstrate the excellent technical results as well as showing how surgery yields a clear improvement in cerebral haemodynamics. However, the majority of ischaemic events reported in the surgery group occurred in the perioperative period, meaning that there were no differences in the rate of stroke at 2 years with respect to the control group with no intervention. In our opinion, along with that of many authors, the benefit of bypass surgery should be evaluated over a much longer follow-up time. In our series, the cerebral complications presented in the perioperative period were not ischaemic, but haemorrhagic in nature. Our experience is in keeping with other lines of evidence that indicate that both ischaemia and symptomatic cerebral hyperperfusion are possible complications of this procedure in the acute postoperative stage. Some series report an incidence of surgery complications of up to 38.5%.<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">30–33</span></a> Despite the close postoperative follow-up of arterial pressure carried out in our centre and recommended by some authors, the incidence of this complication in our series reached 8.7%.<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">30</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Another aspect to take into account in the COSS study is the patient screening criteria. The difficulties associated with performing a PET study may have influenced patient enrolment, since those most clinically affected may have been excluded due to the impossibility of moving them from the intensive care unit and/or hospital for transfer to the PET facilities.<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">5,34–36</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Other aspects taken into account by the literature in search of the benefits of cerebral revascularisation surgery have focused on finding our whether the improvement in cerebral haemodynamics also improves patients’ cognitive status. In this regard, study findings have once again proven to be contradictory. While the Randomized Evaluation of Carotid Occlusion and Neurocognition (RECON) study found no cognitive benefit to cerebral revascularisation surgery in comparison to medical treatment, other studies, such as that by Moser, did find a benefit after the improvement of cerebral haemodynamics.<a class="elsevierStyleCrossRefs" href="#bib0570"><span class="elsevierStyleSup">37,38</span></a> It is worth noting, however, that the primary objective of cerebral revascularisation surgery is not the improvement of cognitive function but its conservation, since the aim is to reduce the risk of new ischaemic events occurring that might cause the patient to deteriorate.</p><p id="par0200" class="elsevierStylePara elsevierViewall">Therefore, the current studies reveal a confusing and contradictory perspective with regard to the scientific evidence on the role of revascularisation surgery in cerebral ischaemia. While the current evidence indicates that revascularisation is a safe technique, with morbidity and mortality rates below 5% and anastomosis patency above 95%, it also suggests that a higher degree of selectivity is needed in order to achieve beneficial results in revascularisation surgery. The evidence shows that the benefit of bypass surgery may be indicated in a limited subgroup of patients with decreased CHR and therefore a poor prognosis. The rate of stroke recurrence in patients with chronic occlusive disease and decreased CHR demonstrated by PET stands at 22.7% at 2 years. Moreover, a large part of the scientific community considers that the conclusions of the COSS study should not be extrapolated until the long-term outcomes are analysed. At our site, the publication of the results of the COSS study forced us to reassess the protocol for treating these patients, such that we added the requirement for symptoms refractory to medical treatment (haemodynamic symptoms caused by postural changes, arterial pressure changes or the onset of progressive infarctions in areas of oligaemic penumbra), as well as decreased CHR demonstrated with a vascular reserve study.</p><p id="par0205" class="elsevierStylePara elsevierViewall">From the point of view of evidence-based medicine, our results are evidently insufficient to confirm that revascularisation surgery offers a better prognosis in these patients. However, the results obtained should force the neurosurgical community to reassess whether these patients might benefit, with more prospective multicentre studies being needed to give clear indications in this field. In the meantime, our recommendation is that patients should be assessed by multidisciplinary units with broad experience in revascularisation techniques, able to offer low indices of complications and high rates of revascularisation.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Moyamoya disease</span><p id="par0210" class="elsevierStylePara elsevierViewall">Moyamoya disease is a clinical condition with a low incidence in our setting, but is extremely important in the cerebral revascularisation field. The aetiology of moyamoya disease is unknown; it was described for the first time by Takeuchi and Shimizu in 1957.<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">39</span></a> It is characterised by progressive stenosis and occlusion of the supraclinoid internal carotid artery and its branches, presenting in infancy and manifesting in the form of ischaemic stroke. The formation of collateral arteries gives a very characteristic angiographic pattern known as a ‘puff of smoke’, which inspired Suzuki and Takayu to coin the term moyamoya (puff of smoke in Japanese) in 1969.<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">40</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">The diagnostic criteria, defined by the Moyamoya Disease Committee of the Japanese Ministry of Health and Welfare, require the presence of bilateral steno-occlusive changes in the terminal segment of the internal carotid artery and/or proximal segments of the middle or anterior cerebral artery, associated with the presence of an abnormal vascular network identifiable during the arterial phase relating to the stenosed artery, and the absence of other systemic diseases that might explain the vasculopathy, for example arteriosclerosis, autoimmune diseases, Down Syndrome, neurofibromatosis type 1 (Von Recklinghausen's disease), cranial irradiation and meningitis (if any of these conditions are present, it is called moyamoya syndrome).<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">41</span></a> The presence of unilateral steno-occlusive involvement associated with the presence of an abnormal vascular network means a probable diagnosis of moyamoya disease, although it is not conclusive.</p><p id="par0220" class="elsevierStylePara elsevierViewall">The disease is much less common in adults than in infancy. In these cases, the fragile collateral vessels often lead the disease to manifest predominantly in the form of haemorrhagic stroke. However, as in our series, recent studies indicate that in the European population, the disease tends to be more prevalent in adults, with an ischaemic onset being much more common in these cases than a haemorrhagic onset.<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">42</span></a> In our series, only five patients were paediatric and only two adult patients had a haemorrhagic onset, the remainder having an ischaemic onset.</p><p id="par0225" class="elsevierStylePara elsevierViewall">Medical treatment in moyamoya disease has not been found to be effective, so revascularisation techniques represent the best therapeutic option in these patients.<a class="elsevierStyleCrossRefs" href="#bib0580"><span class="elsevierStyleSup">39,43</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">There is a large amount of data from neuroradiological studies documenting severe haemodynamic deterioration in moyamoya disease.<a class="elsevierStyleCrossRefs" href="#bib0605"><span class="elsevierStyleSup">44–56</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Several studies in the literature back the role of surgical management in moyamoya disease, and surgery is generally recommended for the treatment of patients with recurrent or progressive cerebral ischaemic events and an associated decrease in cerebral perfusion reserve.<a class="elsevierStyleCrossRefs" href="#bib0595"><span class="elsevierStyleSup">42,43,57–74</span></a> Many different surgical revascularisation techniques have been described for moyamoya disease, but they can essentially be divided into two types: direct and indirect revascularisation. Both have the principal objective of preventing the onset of new ischaemic events by increasing collateral blood flow from the external carotid artery to the hypoperfused areas.<a class="elsevierStyleCrossRefs" href="#bib0580"><span class="elsevierStyleSup">39,42,43,60,63,70,72–76</span></a> The indirect techniques are based on laying vascularised tissue (muscle, dura mater, pericranium, omentum) on the cerebral cortex to promote neoangiogenesis over time, achieving delayed revascularisation. Direct anastomoses consist of a shunt between a donor artery and an intracranial receptor artery. In moyamoya disease, the donor artery is usually the superficial temporal artery and the receptor an M4 cortical branch of the middle cerebral artery.</p><p id="par0240" class="elsevierStylePara elsevierViewall">Indirect revascularisation, usually performed by means of encephaloduroarteriomyosynangiosis (direct application of the superficial temporal artery, dura mater and temporal muscle to achieve synangiosis with the brain) has been found to be a very effective technique in the paediatric population.<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">67</span></a> However, in adults, direct revascularisation by means of an anastomosis between the superficial temporal artery and the middle cerebral artery is recommended for optimal outcomes. This procedure has been found to be effective in particular in forms that present with ischaemic stroke,<a class="elsevierStyleCrossRefs" href="#bib0600"><span class="elsevierStyleSup">43,71</span></a> although the current medical literature suggests that surgical revascularisation treatment also appears to improve the prognosis in haemorrhagic moyamoya disease by reducing the incidence of haemorrhages.<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">77</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">Both techniques have their advantages and disadvantages. Like other authors,<a class="elsevierStyleCrossRefs" href="#bib0735"><span class="elsevierStyleSup">70,73–75</span></a> our results show that one of the advantages of direct versus indirect revascularisation is that a bypass offers a rapid improvement of the cerebral haemodynamics, thereby immediately reducing the incidence of ischaemic stroke. The main disadvantage of bypass surgery is that this type of revascularisation may be difficult to perform in the paediatric population. In our facility, our patency rate is over 95%, with the minimum diameter of the cortical branch of the middle cerebral artery receiving the anastomosis considered to be 0.7<span class="elsevierStyleHsp" style=""></span>mm. Another disadvantage of bypass is the need for antiplatelet treatment which, as can be seen in our series, increases the risk of haemorrhagic complications in the immediate postoperative period.</p><p id="par0250" class="elsevierStylePara elsevierViewall">Regarding indirect revascularisation, the main disadvantage is that several months are needed for the formation of synangiosis, as well as the fact that they do not form at all in approximately half of adult patients. Nevertheless, if synangiosis by indirect revascularisation is effective, it offers better outcomes in terms of blood volume, and its effectiveness has been found to be longer lasting.</p><p id="par0255" class="elsevierStylePara elsevierViewall">In our centre, we always combine direct and indirect revascularisation, which enables us to combine the benefits of immediate effective revascularisation with delayed but more sustained revascularisation.<a class="elsevierStyleCrossRefs" href="#bib0735"><span class="elsevierStyleSup">70,73–75</span></a></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0260" class="elsevierStylePara elsevierViewall">Revascularisation techniques in specialised centres are an indispensable part of the vascular neurosurgeon's arsenal. Cerebral revascularisation by creating an end-to-side anastomosis between the superficial temporal artery and a cortical branch of the middle cerebral artery is without doubt a beneficial technique in the treatment of moyamoya disease and the same may be true in a subgroup of patients with cerebral ischaemia who remain symptomatic in spite of medical treatment, with carotid occlusion and decreased CHR.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0265" class="elsevierStylePara elsevierViewall">The authors declare that there is no conflict of interest relating to the materials and methods used in this study or the results specified in this document.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1046295" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec998159" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1046294" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec998160" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Cerebral haemodynamic reserve study" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Surgical protocol" ] ] ] 6 => array:3 [ "identificador" => "sec0025" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Occlusive ischaemic disease" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Moyamoya disease" ] ] ] 7 => array:3 [ "identificador" => "sec0040" "titulo" => "Discussion" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Cerebral ischaemia caused by carotid artery occlusion" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Moyamoya disease" ] ] ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack353183" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-20" "fechaAceptado" => "2018-01-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec998159" "palabras" => array:6 [ 0 => "Cerebral revascularization" 1 => "Cerebral haemodynamics" 2 => "Moyamoya disease" 3 => "Carotid occlusion" 4 => "Brain ischaemia" 5 => "Extracranial–intracranial bypass" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec998160" "palabras" => array:6 [ 0 => "Revascularización cerebral" 1 => "Hemodinámica cerebral" 2 => "Enfermedad de moyamoya" 3 => "Oclusión carotídea" 4 => "Isquemia cerebral" 5 => "Bypass extracraneal-intracraneal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cerebral revascularization techniques are an indispensable tool in the current armamentarium of vascular neurosurgeons. We present revascularization surgery experience and results in both moyamoya disease and occlusive cerebral ischaemia.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients with ischaemic occlusive disease and moyamoya disease who underwent microsurgical revascularization between October 2014 and September 2017 were analysed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In the study period, 23 patients with occlusive ischaemic disease underwent microsurgical revascularization. Three patients presented with serious postoperative complications (2 intraparenchymal haemorrhages in the immediate postoperative period and one thrombosis of the femoral artery). All patients, except one, achieved normalisation of the cerebral haemodynamic reserve (CHR) in the SPECT study. Twenty patients had a good neurological result, with no ischaemic recurrence of the revascularized territory. Among patients with moyamoya, 20 had moyamoya disease and 5 had moyamoya syndrome with unilateral involvement. Five patients were treated at paediatric age. Haemorrhagic onset occurred in 2 patients. The CHR study showed haemodynamic compromise in all patients. Cerebral SPECT at one year showed resolution of the haemodynamic failure in all patients. There have been 4 postoperative complications (acute subdural haematoma, two subdural collections and one dehiscence of the surgical wound). No patient presented with neurological worsening at 6 and 12<span class="elsevierStyleHsp" style=""></span>months of follow-up.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cerebral revascularization through end-to-side anastomosis between the superficial temporal artery and a cortical branch of the middle cerebral artery is an indisputable technique in the treatment of moyamoya disease and possibly in a subgroup of patients with symptomatic occlusive ischaemic cerebrovascular disease.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las técnicas de revascularización cerebral constituyen una herramienta indispensable en el arsenal actual del neurocirujano vascular. Presentamos la experiencia adquirida y los resultados de la cirugía de revascularización tanto en la enfermedad de moyamoya como en la isquemia cerebral oclusiva.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se analizan los pacientes con enfermedad isquémica oclusiva y enfermedad de moyamoya revascularizados microquirúrgicamente en el periodo comprendido entre octubre de 2014 y septiembre de 2017.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En el periodo de estudio, 23 pacientes con enfermedad isquémica oclusiva han sido revascularizados microquirúrgicamente. Tres pacientes presentaron complicaciones postoperatorias graves (2 hemorragias intraparenquimatosas en el postoperatorio inmediato y una trombosis de la arteria femoral). En todos los pacientes, excepto en uno, el SPECT muestra una normalización de la reserva hemodinámica cerebral (RHC). Veinte pacientes presentaron un buen resultado neurológico, sin recurrencias isquémicas del territorio revascularizado. De la serie de pacientes con moyamoya, 20 presentaban una enfermedad de moyamoya y 5 un síndrome de moyamoya con afectación unilateral. Cinco pacientes fueron tratados en edad pediátrica. Hubo un comienzo hemorrágico en 2 pacientes. El estudio de la RHC mostró un compromiso hemodinámico en todos los pacientes. El SPECT cerebral al año ha mostrado una resolución del fracaso hemodinámico en todos los pacientes. Ha habido 4 complicaciones postoperatorias (hematoma subdural agudo, 2 colecciones subdurales y una dehiscencia de la herida quirúrgica). Ningún paciente ha presentado un empeoramiento neurológico en los controles a los 6 y 12<span class="elsevierStyleHsp" style=""></span>meses.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La revascularización cerebral mediante la realización de una anastomosis termino-lateral entre la arteria temporal superficial y una rama cortical de la arteria cerebral media constituye una técnica indiscutible en el tratamiento de la enfermedad de moyamoya y posiblemente pueda serlo en un subgrupo de pacientes con patología oclusiva isquémica cerebral sintomática.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Arikan F, Rubiera M, Serena J, Rodríguez-Hernández A, Gándara D, Lorenzo-Bosquet C, et al. Experiencia y resultados de las técnicas de revascularización en patología cerebral isquémica: enfermedad de moyamoya y oclusión carotídea. Neurocirugía. 2018;29:170–186.</p>" ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2183 "Ancho" => 2923 "Tamanyo" => 602655 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Illustrative examples of the complexity of current vascular neurosurgical pathology. (A) Giant, thrombotic, calcified aneurysm in the anterior communicating artery. (B) Giant aneurysm in the middle cerebral artery in which the distal branches relating to the aneurysm originate directly from the aneurysmal sac. (C) Thrombotic aneurysm in the P1 segment of the posterior cerebral artery. (D) Very small aneurysm (1.5<span class="elsevierStyleHsp" style=""></span>mm) located in the superior cerebellar artery. (E) Giant, thrombotic and partially embolised aneurysm in which occlusion was attempted by the deployment of a flow-diverting stent shown in F. (G) Surgical image showing the aneurysm from image F; note how the deployed stent can be seen through the carotid artery, as well as the discharges of embolised material at the neck of the aneurysm. (H) Intraoperative video angiography with indocyanine green showing the correct patency of the bypass created and the complete exclusion of the aneurysm from image G. (I) 3D reconstruction of the postoperative angio-CT study for the same patient from images E to H, showing the arterial graft implanted, extending from the left external carotid to the M1 segment of the middle cerebral artery.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1667 "Ancho" => 2903 "Tamanyo" => 558746 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Studies corresponding to patient #21 in the occlusive ischaemic disease series. A 53-year-old male patient with a history of hypertension, smoking, alcoholism, habitual cocaine use and obesity who, after suffering an ischaemic stroke, presented fluctuating symptoms of hemiparesis, hemihypoesthesia and visual alterations, for which he was referred to our centre for cerebral revascularisation assessment. (A) Angiographic study performed by MRI, showing an occlusion of the left internal carotid at the cervical segment. (B) sT2W Flair sequence indicating a subacute ischaemic lesion in the frontal territory of the middle cerebral artery. The vascular reserve study performed by SPECT shows decreased perfusion in the left hemisphere at baseline (C) that clearly worsened after administering acetazolamide (D). (D) Postoperative cranial CT performed 19<span class="elsevierStyleHsp" style=""></span>h after surgery; no procedure-related complications can be seen. At 30<span class="elsevierStyleHsp" style=""></span>h into the postoperative period, the patient presented neurological deterioration in the form of hemiparesis, predominantly of the arm, and motor aphasia secondary to the appearance of an intraparenchymal haematoma quantified at 35<span class="elsevierStyleHsp" style=""></span>cc (F). In G, the tomographic control performed at 6 months, and in H the angio-CT study also performed at 6 months, confirm the patency of the anastomosis created.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1077 "Ancho" => 1417 "Tamanyo" => 254807 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Vascular reserve study performed on patient #6 in the occlusive ischaemic disease series. The preoperative study reveals decreased perfusion in the left hemisphere that worsened dramatically after administration of acetazolamide (positive response). In the follow-up study performed at one year, the patient did not present an improvement in the perfusion of the revascularized hemisphere, with a negative response in the acetazolamide test.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1770 "Ancho" => 2917 "Tamanyo" => 687188 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Images corresponding to patient #13 in the series of patients with moyamoya disease or syndrome. A 49-year-old female patient diagnosed with moyamoya disease after presenting a sudden episode characterised by left arm paresis. The cerebral MRI (A) shows signs of cerebral atrophy with multiple ischaemic lesions at the basal ganglia, numerous signal voids corresponding to characteristic dilation of the lenticulostriate arteries. The cerebral reserve study shows severe involvement of the perfusion of both hemispheres (B) that worsened after administering acetazolamide (C), indicating that the patient is in haemodynamic failure (positive response to the acetazolamide test). (D) and (E) show the lateral and anteroposterior angiographic studies of the right internal carotid, revealing distal occlusion of the carotid without managing to visualise the middle cerebral and anterior cerebral, associated with the presence of an abnormal vascular network in the arterial phase corresponding to the dilated lenticulostriate arteries that give moyamoya disease its characteristic appearance. The formation of these collateral arteries gives a very characteristic angiographic pattern known as a ‘puff of smoke’, which inspired Suzuki and Takayu to coin the term moyamoya (puff of smoke in Japanese) in 1969. The angiographic study reveals multiple synangioses by vessels originating from the external carotid. (F) Surgical detail of the creation of the anastomosis using a 10/0 suture between the superficial temporal artery and a cortical branch of the middle cerebral artery. (G) Intraoperative video angiography with indocyanine green demonstrating the correct patency of the anastomosis. Indirect revascularisation was performed after completing the anastomosis. For this, the temporal muscle and everted dura mater were laid below the margins of the craniotomy to promote the formation of an encephaloduromyosynangiosis. The control angio-CT performed after the second surgical procedure (I) shows the patency of both anastomoses. (K) One-year follow-up of the cerebrovascular reserve by SPECT and after administering acetazolamide. The baseline SPECT (J) shows a global improvement in perfusion in both hemispheres compared with the preoperative SPECT (B). After administering acetazolamide, an improvement can be seen in cerebral perfusion, indicating that the patient presents a preserved vascular reserve (negative response to the acetazolamide test).</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">HTN: hypertension; IC: internal carotid; MCA: middle cerebral artery; T2DM: type 2 diabetes mellitus.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age/gender \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Cardiovascular risk factors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Symptoms for which surgery was indicated \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Radiological characteristics (angiography and MRI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right hemiparesis triggered by orthostasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left IC occlusion Left frontal and border zone ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Motor dysphasia and right arm paresis Fluctuating \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral IC occlusion, right vertebral stenosis Left anterior division and superficial MCA infarction Bilateral border zone infarcts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Smoking, alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Repeated ischaemic stroke Gradual cognitive impairment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral IC occlusion, right vertebral occlusion Predominantly right border zone infarcts \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Blood pressure-related limb shaking and hemiparesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right IC occlusion Right border zone infarct and right MCA territory infarct \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, T2DM, dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Syncopal symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left IC occlusion Left MCA territory infarct \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fluctuating hemiparesis and aphasia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left IC occlusion Left border zone ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, T2DM, dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Repeated right carotid territory stroke \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right IC occlusion Critical left IC stenosis Bilateral border zone ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, dyslipidaemia, T2DM, alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fluctuating left hemiparesis and hemihypoesthesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right IC occlusion Left IC stenosis of 50–70% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fluctuating language impairment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left IC occlusion Critical right IC stenosis Left superficial MCA territory and border zone ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, cocaine, obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Repeated stroke \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left IC occlusion Multiple left ischaemic lesions at various temporal stages \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, T2DM, dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Repeated stroke Left hemiparesis triggered by orthostasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right IC occlusion Right MCA and border zone ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Repeated stroke Fluctuating hemiparesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right IC occlusion MCA territory ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fluctuating language impairment and bradyphrenia symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left IC occlusion Left border zone ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fluctuating right hemiparesis and hemihypoesthesia Episodes of amaurosis fugax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left IC occlusion Critical right IC stenosis Bilateral border zone ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left hemiparesis and hemihypoesthesia triggered by orthostasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right IC occlusion Right MCA and border zone ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, T2DM, dyslipidaemia, obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Repeated stroke, limb shaking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right IC occlusion Right MCA and border zone ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, T2DM, dyslipidaemia, alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Repeated stroke \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right IC occlusion Right MCA territory and border zone ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Repeated stroke Fluctuating hemihypoesthesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right IC occlusion Left IC stenosis of 50–70% Right superficial MCA territory ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fluctuating language impairment and paraesthesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left IC occlusion Right vertebral stenosis<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>70% Right superficial MCA territory ischaemic lesion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fluctuating left hemiparesis and paraesthesia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right IC occlusion Right deep MCA territory ischaemic lesion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, alcoholism, cocaine, obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fluctuating hemiparesis, hemihypoesthesia and visual alterations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left IC occlusion Left anterior frontal ischaemic lesion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, smoking, T2DM, dyslipidaemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Limb shaking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Right IC occlusion Right border zone ischaemic lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HTN, dyslipidaemia, alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Limb shaking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Left IC occlusion \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1778188.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Clinical and radiological characteristics of the series revascularized due to occlusive ischaemic disease.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">mRankin preoperative \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">mRankin postoperative (6 months) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">mRankin postoperative (1 year) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vascular reserve \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vascular reserve at 6 months (baseline SPECT/acetazolamide) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Angiographic patency of bypass (immediate postoperative/1 year) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Complications \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Time since surgery (months)/stroke after surgery \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 months/absence of new clinical and radiological ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 months/absence of new clinical and radiological ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 months/aneurysmal SAH and death/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 months/ischaemic stroke (26 months) in right MCA territory due to right carotid occlusion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased (apnoea Doppler test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased (apnoea Doppler test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intraparenchymal haemorrhage in immediate postoperative period (surgical evacuation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased (apnoea Doppler test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No follow-up \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Femoral artery thrombosis after postoperative arteriography (amputation), sepsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">N/A \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased (apnoea Doppler test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased (apnoea Doppler test) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intraparenchymal haemorrhage in immediate postoperative period (surgical evacuation) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">mRS 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes/– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 months/clinical and radiological absence of new ischaemic events \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1778186.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Patient showed no improvement in cerebral perfusion after administration of acetazolamide (positive response). However, despite continuing to have a decreased reserve, this patient presented an improvement with regard to the baseline SPECT, in which, after administering acetazolamide, there was a severe reduction, primarily in the right hemisphere.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Haemodynamic and clinical outcomes of the series of patients with occlusive ischaemic disease.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age/gender \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Moyamoya disease/moyamoya syndrome \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical onset \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Bilateral or unilateral revascularisation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Direct revascularisation: left hemisphere \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Indirect revascularisation: left hemisphere \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Direct revascularisation: right hemisphere \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Indirect revascularisation: right hemisphere \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">53/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Haemorrhagic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Haemorrhagic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">55/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25/♂ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unilateral Pending surgery on contralateral hemisphere \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56/♀ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ischaemic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Unilateral Pending surgery on contralateral hemisphere \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1778187.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Surgical and clinical aspects of the series of patients with moyamoya disease or syndrome.</p>" ] ] 7 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vascular reserve (baseline SPECT/acetazolamide) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Vascular reserve at 1 year (baseline SPECT/acetazolamide) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Preoperative mRankin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative mRankin (6 months) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Postoperative mRankin (1 year) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Surgical complications \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Acute subdural haematoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chronic subdural haematoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Wound dehiscence \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preserved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Chronic subdural haematoma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decreased \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pending \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1778185.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Haemodynamic and clinical outcomes of the series of patients with moyamoya disease or syndrome.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:77 [ 0 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=> "Cerebral hemodynamic impairment: methods of measurement and association with stroke risk" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ …3] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "1999" "volumen" => "53" "paginaInicial" => "251" "paginaFinal" => "259" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0480" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "1998" "volumen" => "280" "paginaInicial" => "1055" "paginaFinal" => "1060" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => 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