Extracranial-intracranial arterial bypass for treatment of occlusion of the internal carotid artery.
Extracranial-intracranial arterial bypass was frequently utilized in the 1970s and early 1980s to treat patients with atherosclerotic occlusive carotid arterial lesions not amenable to extracranial arterial revascularization procedures. After a large randomized trial reported in 1985 that there was no benefit of surgery in these patients, the procedure was generally abandoned as a treatment for symptomatic atherosclerotic cerebrovascular disease. In the past two decades, multiple studies have shown that patients with impaired cerebral hemodynamics distal to an occlusive cerebrovascular lesion have a significantly increased risk of subsequent stroke. Two new randomized, controlled clinical trials of extracranial-intracranial arterial bypass in patients with symptomatic atherosclerotic occlusive cerebrovascular disease that are using cerebral hemodynamic criteria for patient selection are currently in progress. At the present time, extracranial-intracranial arterial bypass should not be performed on these patients outside of a clinical trial.
Grubb
Robert L
RL
Department of Neurological Surgery, Washington University School of Medicine, Campus Box 8057, 660 South Euclid Avenue, St. Louis, MO 63110-1093, USA. grubbr@nsurg.wustl.edu
D002341:Carotid Artery Thrombosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D006801:Humans; D018579:Patient Selection; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome