Current evidence on the safety and efficacy of laser-assisted cerebral vascular anastomosis without temporary arterial occlusion is based on very limited numbers of patients. Therefore, the procedure should only be used with special arrangements for clinical governance, consent, and audit or research.
Clinicians wishing to undertake laser-assisted cerebral vascular anastomosis without temporary arterial occlusion should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In addition, use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having laser-assisted cerebral vascular anastomosis without temporary arterial occlusion (see section 3.1).
Selection of patients for this procedure should be carried out in the context of a multidisciplinary team including a neurosurgeon and an interventional neuroradiologist.
Publication of safety and efficacy outcomes will be useful. NICE may review the procedure upon publication of further evidence.