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Long-term Prognosis after Extracranial-intracranial Bypass Surgery for Symptomatic Cerebrovascular Occlusive Disease
Hideki Komatani1, Yuji Okamoto1, Takachika Aoki2
1Department of Neurosurgery, Saiseikai Yahata General Hospital.
Insights
Extracranial-intracranial (EC-IC) bypass surgery offers a good long-term prognosis for patients with occlusive cerebrovascular disease, especially when avoiding complications. Survival rates are favorable, though older age at surgery is linked to poorer outcomes.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Extracranial-intracranial (EC-IC) bypass surgery benefits remain debated.
- Long-term prognosis after EC-IC bypass requires further investigation.
- Symptomatic occlusive cerebrovascular disease necessitates effective treatment strategies.
Purpose of the Study:
- To evaluate the long-term prognosis of patients undergoing EC-IC bypass surgery.
- To identify factors influencing long-term survival post-EC-IC bypass.
- To assess the rate of recurrent ischemic stroke after EC-IC bypass.
Main Methods:
- Single-center retrospective study of 57 patients (1991-2003) with symptomatic internal carotid artery or intracranial occlusive disease.
- Patients selected based on good modified Rankin Scale (mRS) scores (0-2) at 30 days post-surgery.
- Analysis of survival rates, causes of death, and recurrent stroke rates between survivors and non-survivors.
Main Results:
- 16 patients (28%) died during a mean follow-up of 8.3 years; survivors had a significantly longer follow-up (12.0 years).
- Non-survivors were significantly older at the time of surgery (mean 71.5 years vs. survivors).
- Pneumonia/respiratory diseases (31.2%) and cerebrovascular disease (12.5%) were primary causes of death; recurrent ischemic stroke rate was 28% with no significant group difference.
Conclusions:
- EC-IC bypass surgery demonstrates a very good long-term prognosis in patients without perioperative complications.
- Older age at surgery is a significant negative prognostic factor for long-term survival.
- The study supports the efficacy of EC-IC bypass in selected patients with occlusive cerebrovascular disease.
Abstract:
Prognosis after extracranial-intracranial (EC-IC) bypass surgery has only been studied for a few years and the benefits of this procedure are still controversial. In this single-center retrospective study, we examined the long-term prognosis of patients who underwent EC-IC bypass surgery. Subjects were patients with symptomatic internal carotid artery or intracranial lesion occlusive disease who underwent EC-IC bypass surgery between 1991 and 2003. Of these, long-term prognosis was examined in 57 patients (39 male, 18 female; mean age, 61.8 years) who showed good surgical outcomes 30 days after bypass surgery, measured as a 0-2 on the modified Rankin Scale (mRS). They were divided into 2 groups (survivors and non-survivors) and were analyzed to identify factors effecting long-term survival after bypass surgery. Sixteen patients (28%), whose mean follow-up period (survival time) was 8.3±3.8 years, died after the bypass surgery. The average follow-up period for the survivors was 12.0±1.1 years, which was significantly longer than that for the non-survivors (P<0.0001). At surgery, the non-survivors (mean age 71.5 years) were significantly older than the survivors (P=0.0012). Pneumonia and other respiratory diseases were a frequent cause of death (31.2%), but death by cerebrovascular disease also occurred (12.5%). The rate of recurrent ischemic stroke was 28%, with no significant difference between groups (survivors vs. non-survivors: 31.2% vs. 26.1%, P= 0.82). In the absence of perioperative complications, the long-term prognosis of patients who underwent EC-IC bypass surgery was very good.
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