[Can EC-IC bypass prevent brain ischemia from recurring?].
The effectiveness of extracranial-intracranial arterial bypass (EC-IC bypass) surgery for patients with hemodynamic compromise still remains controversial. In the present study, we evaluated the correlation between the pre- and post-surgical cerebral hemodynamics and long-term prognosis. 28 patients and a subsequent 21 patients (41 men, eight women: mean age 59.9 [S.D. 8.6] years) with reduced cerebrovascular reserve due to steno-occlusive disease of the cerebral major arteries formed the study groups 1 and 2, respectively. Measurement of the mean hemispheric cerebral blood flow (mCBF) and the cerebral vasoreactivity (%mCVR) with an intravenous acetazolamide injection were performed by a 133Xe inhalation method and SPECT. Patients were treated with EC-IC bypass surgery and measurement of mCBF and %mCVR were made again about one month after surgery. The patients were observed for a long period (mean 44.3 months). During the follow-up period, 6 patients experienced recurrent ischemic strokes. The annual incidence of recurrent ischemic stroke was 4.4%. The patients with significantly reduced pre- and post-surgical resting mCBF of the affected hemisphere were at significantly higher risk of recurrent ischemic stroke than the patients with normal mCBF (p < 0.01). The %mCVR of the affected hemisphere rose after surgery.
Department of Neurosurgical Surgery, Hokkaido University School of Medicine, Japan.
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Ishikawa
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Kuroda
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Hokin
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Kamiyama
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Abe
D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000503:physiopathology / Q000517:prevention & control*; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence