The role of indirect extracranial-intracranial bypass in the treatment of symptomatic intracranial atheroocclusive disease

Abstract

The authors found that indirect bypass does not promote adequate pial collateral artery development and appears to be of limited utility in patients with symptomatic ICA or MCA stenoocclusive disease and secondary hemodynamic failure. Rates of postoperative TIAs or cerebral infarctions after indirect bypass in this patient population do not differ from previous reports in patients who received medical management only.

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

“…Pilot studies examining indirect surgical techniques (for example, encephaloduroarteriosynangiosis [EDAS]) in patients with ischemic cerebrovascular disease and impaired cerebral hemodynamics suggest that less invasive approaches toward achieving surgical revascularization are similarly ineffective and therefore not likely indicated. 25 However, as with all clinical trials, there always, at least theoretically, may exist highly select subgroups of patients who were not specifically analyzed in the aforementioned trials. Such subgroups may be postulated and may serve as the basis for future trials, as was done for those with hemodynamic ischemia and COSS.…”

Role of and Indications for Bypass Surgery After Carotid Occlusion Surgery Study (COSS)?

“…Методы непрямой церебральной реваскуляризации при васкулопатиях, отличных от мойя-мойя, считают-ся неэффективными [28,29] вследствие предполагае-мого отсутствия ангиогенной среды, ассоциированной с БММ, хотя в небольших сериях случаев был продемон-стрирован некоторый ограниченный успех при приме-нении стратегий непрямого шунтирования [30]. В насто-ящее время в США проводят РКИ, EDAS (Surgical) Revascularization in patients with Symptomatic Intracranial Arterial Stenosis (ERSIAS), результаты которого позво-лят прояснить некоторые вопросы о роли непрямо-го шунтирования при атеросклеротической болезни (ClinicalTrials.gov NCT01819597; ЭДАС: энцефало-дуро-артерио-синагиоз).…”

“…4,5 Indirect cerebral revascularization methods are felt to be largely ineffective for non-moyamoya vasculopathy 28,29 because of the presumed absence of the angiogenic milieu associated with MMD, although small case series have suggested some limited success with indirect strategies. 30 Currently, a RCT, the EDAS (Surgical) Revascularization in patients with Symptomatic Intracranial Arterial Stenosis (ERSIAS) is underway in the United States, which may provide some insights into the role of indirect bypass for atherosclerotic disease (ClinicalTrials.gov NCT01819597; EDAS: encephalo-duro-arterio-synangiosis).…”

Clinical Reasoning: A case of progressive cognitive decline reversed by middle cerebral artery stent placement

“…6 Cognitive improvement after revascularization of extracranial carotid disease by carotid endarterectomy, carotid artery stenting, or extracranial/intracranial (EC/IC) bypass has been reported. 7 Over the past decade, angioplasty and stenting have emerged as therapeutic options for symptomatic intracranial arterial stenosis. 3 In clinical settings, the relationship between chronic cerebral hypoperfusion and cognitive function is often difficult to confirm as factors such as aging, systemic disease, or educational background can influence cognitive performance.…”