(Kiosk 4) Rehabilitation Outcome of Encephalo-duro-arterio-synangiosis(edas) for Recurrent Stroke: A Case Report

Case Diagnosis: A 68-year-old male received indirect revascularization in the setting of severely stenotic intracranial atherosclerotic disease (ICAD) with frequent recurrences of stroke; right ICA occlusion as well as bihemispheric strokes with the most recent stroke in the right parietal region despite optimal intensive medical management.

Case Description or Program Description: The patient with the continued failure of medical management underwent Encephalo-duro-arterio-synangiosis(EDAS) surgery as a result of limited options and potential benefits of the novel approach for significant ICAD. Post-operatively, he was hospitalized in acute inpatient rehabilitation for 3 weeks and continues outpatient rehabilitation with targeted goals of recovery managed by a brain injury physiatrist, physical, occupational, and speech therapists.

Setting: Acute inpatient and outpatient rehabilitation.

Assessment/Results: Functional status on admission scored as dependent level in all ADLs, Mobility, and Transfers. At discharge from inpatient, noted improved mobility function from dependant to maximal assistance with the use of a manual wheelchair although most of ADLs remained dependent level. At 12 weeks post-surgery, noted continued improving mobility function, he was able to ambulate 15ft with close supervision with a rolling walker and ADLs at maximal assistance level.

Discussion (relevance): EDAS is a form of indirect revascularization has been utilized for moyamoya disease, and its use has been extended to the treatment of symptomatic ICAD failing medical management in clinical trials. Here we present a patient with functional progress which highlighted the importance of continued post-surgery rehabilitation and a team-based collaborative approach is beneficial for one of the patients to receive the EDAS in the setting of ICAD with recurrent stroke despite optimal medical management.

Conclusions: Post-EDAS Revascularization rehabilitation in patient with symptomatic intracranial arterial stenosis demonstrated improved functional outcomes.