[Can EC-IC bypass prevent brain ischemia from recurring?]

The effectiveness of extracranial-intracranial arterial bypass (EC-IC bypass) surgery for patients with hemodynamic compromise still remains controversial. In the present study, we evaluated the correlation between the pre- and post-surgical cerebral hemodynamics and long-term prognosis. 28 patients and a subsequent 21 patients (41 men, eight women: mean age 59.9 [S.D. 8.6] years) with reduced cerebrovascular reserve due to steno-occlusive disease of the cerebral major arteries formed the study groups 1 and 2, respectively. Measurement of the mean hemispheric cerebral blood flow (mCBF) and the cerebral vasoreactivity (%mCVR) with an intravenous acetazolamide injection were performed by a 133Xe inhalation method and SPECT. Patients were treated with EC-IC bypass surgery and measurement of mCBF and %mCVR were made again about one month after surgery. The patients were observed for a long period (mean 44.3 months). During the follow-up period, 6 patients experienced recurrent ischemic strokes. The annual incidence of recurrent ischemic stroke was 4.4%. The patients with significantly reduced pre- and post-surgical resting mCBF of the affected hemisphere were at significantly higher risk of recurrent ischemic stroke than the patients with normal mCBF (p < 0.01). The %mCVR of the affected hemisphere rose after surgery.