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Long-term evaluation of EC-IC bypass patency
U Schick1, M Zimmermann, D Stolke
1Department of Neurological Surgery, University Hospital GHS Essen, Federal Republic of Germany.
Acta Neurochirurgica
|January 1, 1996
Summary
Extracranial-intracranial (EC-IC) bypass surgery offers limited long-term stroke prevention benefits. While some patients show improvement, bypass graft patency declines over time, suggesting limited utility.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Extracranial-intracranial (EC-IC) bypass surgery was re-evaluated for specific stroke prevention cases.
- Previous studies, like the EC-IC Bypass Study Group in 1985, showed no clear surgical benefit.
- Recurrent focal cerebral ischemia with impaired hemodynamics prompted re-evaluation of surgical revascularization.
Purpose of the Study:
- To examine the long-term benefits and patency rates of EC-IC bypass surgery.
- To assess the efficacy of bypass surgery in patients with recurrent ischemic events due to carotid artery occlusion.
Main Methods:
- Retrospective study of 47 patients undergoing EC-IC bypass after 1985.
- Follow-up averaged 5.6 years, assessing neurological status, TCD, angiography, CT, and SPECT.
- Analysis included patency rates of vein grafts and STA-MCA procedures.
Main Results:
- Neurological improvement seen in 23% of patients; early surgery yielded better results.
- 22% experienced worsening with further ischemic events.
- Vein graft patency was 50%, STA-MCA procedure patency was 91%; graft occlusion occurred over time.
Conclusions:
- EC-IC bypass provides limited long-term benefit for stroke prevention.
- Bypass graft function deteriorates, suggesting primary benefit within the first year post-ischemia.
- Indications may include patients with maximal medical therapy failure, progressive ischemia, and hemodynamic compromise.