Extracranial–intracranial bypass in atherosclerotic cerebrovascular disease: report of a single centre experience
- 18 April 2011
- journal article
- research article
- Published by Informa UK Limited in British Journal Of Neurosurgery
- Vol. 25 (3), 357-362
- https://doi.org/10.3109/02688697.2010.551673
Abstract
Despite the failure of the international extracranial-intracranial (EC-IC) bypass study in showing the benefit of bypass procedure for prevention of stroke recurrence, it has been regarded to be beneficial in a subgroup of well-selected patients with haemodynamic impairment. This report includes the EC-IC bypass experience of a single centre over a period of 14 years. All consecutive 72 patients with atherosclerotic occlusive cerebrovascular lesions associated with haemodynamic compromise treated by EC-IC bypass surgery were retrospectively reviewed. Pre-operatively, 61% of patients presented with minor stroke and the remaining 39% with recurrent transient ischemic attacks (TIAs) despite maximal medical therapy. Angiography revealed a unilateral internal carotid artery (ICA) stenosis/occlusion in 79%, bilateral ICA stenosis/occlusion in 15%, MCA stenosis/occlusion in 3% and other multiple vessel stenosis/occlusion in 3% of the cases. H(2)(15)O positron emission tomography (PET) or 99mTc-HMPAO SPECT with acetazolamide challenge was performed for haemodynamic evaluation of the cerebral blood flow (CBF). All the patients had impaired haemodynamics pre-operatively in terms of reduced regional cerebrovascular reserve capacity and rCBF. Standard STA-MCA bypass procedure was performed in all patients. A total of 68 patients with 82 bypasses were reviewed with a mean follow-up period of 34 months. Stroke recurrence took place in 10 patients (15%) resulting in an annual stroke risk of 5%. Improved cerebral haemodynamics was documented in 81% of revascularised hemispheres. Patients with unchanged or worse haemodynamic parameters had significantly more post-operative TIAs or strokes when compared to those with improved perfusion reserves (30% vs.5% of patients, p<0.05). In conclusion, EC-IC bypass procedure in selected patients with occlusive cerebrovascular lesions associated with haemodynamic impairment has revealed to be effective for prevention of further cerebral ischemia, when compared with a stroke risk rate of 15% reported to date in patients only under antiplatelet agents or anticoagulant therapyKeywords
This publication has 22 references indexed in Scilit:
- The Extracranial–Intracranial Bypass Trial: implications for future investigationsNeurosurgical Focus, 2008
- Cerebrovascular Reactivity to Acetazolamide and Outcome in Patients With Symptomatic Internal Carotid or Middle Cerebral Artery OcclusionStroke, 2002
- Long-Term Prognosis of Medically Treated Patients With Internal Carotid or Middle Cerebral Artery OcclusionStroke, 2001
- Symptomatic Carotid Artery OcclusionStroke, 1997
- EC-IC bypass 10 years later: Is it valuable?Surgical Neurology, 1996
- Was the International Randomized Trial of Extracranial-Intracranial Arterial Bypass Representative of the Population at Risk?New England Journal of Medicine, 1987
- Atherosclerotic disease of the middle cerebral artery.Stroke, 1986
- Critique of the extracranial-intracranial bypass studySurgical Neurology, 1986
- Failure of Extracranial–Intracranial Arterial Bypass to Reduce the Risk of Ischemic StrokeNew England Journal of Medicine, 1985
- Cerebral angiographic and clinical differences in carotid system transient ischemic attacks between American Caucasian and Japanese patients.Stroke, 1984