Clinical experience with extra-intracranial arterial anastomosis in 65 cases

Abstract

Clinical results of an extra-intracranial arterial bypass (EIAB) procedure for cerebral ischemia are assessed in 65 patients. The 5-year-study suggests that the EIAB procedure has a protective effect against further clinically significant cerebrovascular accidents in properly selected patients. Correlation with angiography and regional cerebral blood flow (rCBF) studies are discussed. It is felt that rCBF measurements offer the best diagnostic test to determine which patients are suitable for surgery by revealing if an ischemic or relative ischemic focus is present. The surgical procedure is contraindicated in acute cerebral ischemia and when the rCBF study reveals general reduction of cerebral blood flow as opposed to a localized ischemic focus.

Flow thresholds of functional and morphological damage of brain tissue.

“…After focal ischemic attacks symptoms may recover completely or partially either shortly after the occurrence of the deficits or more rarely with long intervals after the onset, and such improvements may occur spontaneously, 35 or after surgical revascularization, [36][37][38] perfused at a value insufficient for functional activity but adequate for structural integrity. Slight flow increases restore function in viable cells.…”

Extracranial-intracranial bypass for ischemic cerebrovascular disease: what have we learned from the Carotid Occlusion Surgery Study?

“…In the 1970s and early 1980s, multiple small retrospective case series documented the safety record and apparent efficacy of this procedure. 2,8,18,43,46,50 While the majority of these studies included patients with heterogeneous disease processes (for example, intracranial anterior circulation stenosis, intracranial posterior circulation stenosis, extracranial ICA stenoocclusion, moyamoya disease, and ICA dissection), the minority focused on patients with symptomatic extracranial ICA occlusion.…”

Graft selection in cerebral revascularization

“…4 Bypass procedures utilizing the STA as the graft of choice have played an important role in certain cases of occlusive disease, complex aneurysms, and tumors. 1,5,6,8,10,12,13,16,19,32,33 Despite the 1985 randomized trial 3 that indicated no increased benefit of the STA-MCA bypass over medical therapy for atherosclerotic lesions of the ICA, this therapeutic option remains available in the management of a subset of patients with occlusive cerebrovascular disease.…”