title: A new type of extracranial/intracranial bypass for recurrent haemodynamic transient ischaemic attacks.
abstract: Since the completion of the international extracranial/intracranial (EC/IC) bypass study in 1985, no treatment of proven value has become available for patients with symptomatic carotid artery occlusion other than treatment with antithrombotic medication. However, in this trial the causal factors of cerebral ischaemia were not part of the inclusion criteria and also patients with single episodes only were included. We report successful Excimer laser-assisted high flow EC/IC bypass surgery in a patient with frequent transient ischaemic attacks associated with a low flow state of the cerebral circulation. In the 1.5 years after the operation the patient has never again experienced any symptoms of cerebral ischaemia. In addition there was improvement in cerebral blood flow, measured by magnetic resonance spectroscopy and hexamethylpropyleneamine oxime single photon emission computed tomography. Certain patients with occlusion of the internal carotid artery may benefit from EC/IC bypass surgery, in particular the Excimer laser-assisted high-flow bypass, that is, if recurrent (transient) ischaemic attacks are associated with compromised cerebral perfusion.
authors.affiliation: University Department of Neurology, University Hospital Utrecht, The Netherlands. cklijn@neuro.azu.nl
authors.forename: C J
authors.initials: CJ
authors.lastname: Klijn
authors.forename: L J
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: J
authors.initials: J
authors.lastname: van der Grond
authors.forename: J
authors.initials: J
authors.lastname: van Gijn
authors.forename: C A
authors.initials: CA
authors.lastname: Tulleken
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D053685:Laser Therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D019275:Radiopharmaceuticals; D012008:Recurrence; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime