What surgical treatments exist?
Bypassing the occlusive segments is the aim of most surgical therapy. In adults external carotid artery to middle cerebral artery (ECA-MCA) anastamoses can be performed as the vessles are larger typically using the superficial temporal artery (STA-MCA bypass). Encephaloduroarteriosynangiosis is the treatment of choice in pediatric patients as thier vessles are too small to allow direct anastomosis.
Angiogram confirms extensive perforator colaterals giving the 'puff of smoke' characteristic of this disease, and involving both anterior and posterior circulation.