title: Revascularization of cerebral ischemia after previous bilateral extracranial-intracranial bypass procedures.
abstract: Extracranial-intracranial (EC-IC) bypass grafting procedures were specially designed for treatment of bilateral internal carotid artery occlusion. When performed in an expeditious manner, EC-IC bypass procedures have produced effective and durable results, despite the recent disfavor given to this procedure. This communication reports a 68-year-old white man who developed generalized cerebral ischemia manifested as confusion, incoherence, disorientation, ataxia, and numerous episodes of syncope daily. A cerebral angiogram revealed bilateral external carotid arteries and left solitary vertebral artery critical stenosis. Transcranial Doppler study demonstrated reduction of cerebral and vertebral-basilar perfusion. However, the patient's EC-IC bypass graft had remained patent since 1985. The patient's recurrent symptoms of global ischemia and syncope resolved after carotid endarterectomy, vein patch external carotid artery, and vertebral-to-common carotid artery transposition. This report reiterates the value of the EC-IC bypass procedure and presents the surgical management of symptomatic external carotid and vertebral artery stenosis in patients after EC-IC bypass procedures.
authors.affiliation: Department of Surgery, Louisiana State University School of Medicine, New Orleans 70112-2822, USA.
authors.forename: V S
authors.initials: VS
authors.lastname: Sottiurai
authors.forename: L
authors.initials: L
authors.lastname: Herbert
authors.forename: D
authors.initials: D
authors.lastname: Hatter
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D003251:Constriction, Pathologic; D016894:Endarterectomy, Carotid; D006801:Humans; D008297:Male; D012086:Reoperation; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery