Ruby had her one year follow up with the surgeon yesterday.  Based on the results of her angio from last week, the good news is that the two pial synangiosis surgeries were a success, with perfusion from new vessel growth in both the pial and dural layers.

The not so great news is that there is a third stenotic artery (can't recall the name, but it's in the occipital lobe and I believe it supplies the vessels in the eyes, among other things) and it is slightly more stenotic than it was one year ago. 

According to the surgeon, the criteria for doing the indirect bypass on this artery is not as straightforward as recommending it for the carotids.  The surgeon will see Dr. Scott at a conference in December (he's her mentor) so she plans to consult w/him then about the best way to proceed. 

Since Ruby has never had any TIA activity in that region of the brain and her vision is currently OK the surgeon doesn't believe she's at great risk for stroke/TIA from the stenosis at this point and feels comfortable waiting until school's out the end of May to make a decision about a 3rd surgery, if it is indeed indicated. 

I knew this was a possibility going into the appt. yesterday but was hopeful that perhaps there would have been no change in the stenosis in the artery, but that was not to be.

It is just difficult to think about Ruby possibly having to go thru the surgery again next summer.  But, if that's what she needs to remain healthy and keep her vision in tact, then that is, of course, what we'll do.

Has anyone else ever faced this issue?

Best regards,

Jennifer