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

T Ishikawa1, S Kuroda, K Hokin

  • 1Department of Neurosurgical Surgery, Hokkaido University School of Medicine, Japan.

No Shinkei Geka. Neurological Surgery
|October 3, 1998
PubMed
Summary

Extracranial-intracranial arterial bypass (EC-IC bypass) surgery may not improve outcomes for all patients with hemodynamic compromise. Reduced cerebral blood flow before and after surgery indicates a higher risk of recurrent ischemic stroke.

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Area of Science:

  • Neurosurgery
  • Neurology
  • Vascular Surgery

Context:

  • The efficacy of extracranial-intracranial arterial bypass (EC-IC bypass) surgery for patients experiencing hemodynamic compromise remains a subject of debate.
  • Steno-occlusive disease affecting major cerebral arteries can lead to reduced cerebrovascular reserve.

Purpose:

  • To investigate the relationship between pre- and post-operative cerebral hemodynamics and the long-term prognosis in patients undergoing EC-IC bypass surgery.
  • To assess the impact of EC-IC bypass on cerebral blood flow and vasoreactivity.

Summary:

  • This study evaluated 49 patients with reduced cerebrovascular reserve due to steno-occlusive disease who underwent EC-IC bypass surgery.
  • Cerebral hemodynamics, including mean hemispheric cerebral blood flow (mCBF) and cerebral vasoreactivity (%mCVR), were measured before and after surgery using a 133Xe inhalation method and SPECT.

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  • Over a mean follow-up of 44.3 months, 6 patients (4.4% annual incidence) experienced recurrent ischemic strokes.

    • Impact:

    • Patients with significantly reduced pre- and post-surgical resting mCBF in the affected hemisphere faced a higher risk of recurrent ischemic stroke.
    • EC-IC bypass surgery led to an increase in the %mCVR of the affected hemisphere.