The Role of EC-IC Bypass in Critical Cerebral Hemodynamics of Different Origin

Bernhard   R.   Fischer; Stefan      Palkovic; Markus      Holling; Matthias      Weckesser; Thomas      Niederstadt; Hansdetlef      Wassmann

Abstract

Stroke is a great matter of interest especially in the industrialised countries, because of pronounced morbidity and mortality. Recurrent ischemic brain attacks are usually caused due to embolism by arrhythmic heart diseases or by occlusive disease of carotid artery (CA) due to atherosclerosis, furthering with risk factors such as hypertension, metabolic disorders, smoking, and other life-style factors. In patients with CA occlusion and reduced cerebrovascular reserve capacity (CVR), revealed by different technical modalities of CCT, MRI or PET, the EC-IC bypass can apparently prevent recurrent ischemic attacks. Some studies as well as own experiences with brain revascularisation by means of EC-IC bypass, has documented cessation of symptoms in majority of patients. Brain revascularisation should be taken into account in the proper group of patients with occlusion of CA, if sufficient anticoagulating therapy is not effective. Which of the patients with recurrent ischemic stroke based on occluded CA are proper candidates for the revascularization is not definitive. Further trials especially for redefined subgroups of patients must bring decision in this matter, as recommended by the Carotid Occlusion Surgery Study group. Unfortunately, the data published in 1985 by the EC-IC Bypass Study Group do not considered diverse subgroups of patients and their differed CVR owing to occlusion of internal carotid artery. This issue should be a matter of interest for the future.

Keywords: Extracranial-intracranial bypass, moyamoya disease, carotid occlusion, recurrent stroke, cerebrovascular reserve capacity

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