Related Experiment Video

Updated: Jun 7, 2026

Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
07:46

Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia

Published on: May 9, 2013

29.4K

Extracranial-intracranial bypass for symptomatic intracranial arterial occlusion: a meta-analysis of individual

Jin Hean Koh1, Claire Yi Jia Lim2, Lucas Tze Peng Tan2

  • 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Singapore Medical Journal
|August 28, 2025
PubMed

Insights

Adding extracranial-intracranial (EC-IC) bypass surgery to medical therapy does not significantly reduce the risk of stroke or death in patients with symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusions. This finding is based on a meta-analysis of recent randomized trials.

Area of Science:

  • Neurology
  • Neurosurgery
  • Cardiovascular Medicine

Background:

  • Patients with symptomatic atherosclerotic internal carotid artery (ICA) or middle cerebral artery (MCA) occlusions have a high risk of recurrent ischemic stroke.
  • Previous trials suggested no benefit from extracranial-intracranial (EC-IC) bypass surgery, potentially due to underpowering.

Purpose of the Study:

  • To evaluate the efficacy of EC-IC bypass surgery in reducing the risk of stroke or death in patients with symptomatic ICA or MCA occlusions.
  • To analyze data from randomized trials comparing EC-IC bypass plus medical therapy versus medical therapy alone.

Main Methods:

  • Systematic review of randomized trials from PubMed, Embase, and Cochrane Library.
  • Meta-analysis using reconstructed individual patient data (one-stage and two-stage) to calculate hazard ratios (HRs).
  • Primary outcome: composite of stroke or death within 30 days, or ipsilateral ischemic stroke beyond 30 days up to 2 years.

Main Results:

  • Four trials with 2102 participants were included in the meta-analysis.
  • No statistically significant difference in the primary composite outcome was found between the EC-IC bypass group and the medical therapy alone group (one-stage HR 1.019, P=0.06; two-stage HR 0.954, P=0.21).
  • Rates of ipsilateral ischemic stroke, any stroke or death, and any stroke were similar between groups at 2 years.

Conclusions:

  • Adding EC-IC bypass surgery to medical therapy does not significantly lower the risk of the composite outcome of stroke or death in patients with symptomatic ICA or MCA occlusions.
  • The findings suggest that current medical therapy alone is as effective as adding bypass surgery for stroke prevention in this patient population.

Keywords:
Acute strokebrainischaemic strokethrombolysis

More Related Videos

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection08:22

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection

Published on: July 21, 2013

15.1K
Optimization of the Longa Middle Cerebral Artery Occlusion Method for Complete Reperfusion13:18

Optimization of the Longa Middle Cerebral Artery Occlusion Method for Complete Reperfusion

Published on: November 22, 2024

1.2K

Related Concept Videos

Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

Aneurysm II: Clinical Manifestations and Diagnostic Studies

Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...