title: Results of Prospective Cohort Study on Symptomatic Cerebrovascular Occlusive Disease Showing Mild Hemodynamic Compromise [Japanese Extracranial-Intracranial Bypass Trial (JET)-2 Study].
abstract: The purpose of this study is to determine the true threshold of cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) for subsequent ischemic stroke without extracranial-intracranial (EC-IC) bypass surgery in patients with hemodynamic ischemia due to symptomatic major cerebral arterial occlusive diseases. Patients were categorized based on rest CBF and CVR into four subgroups as follows: Group A, 80% < CBF < 90% and CVR < 10%; Group B, CBF < 80% and 10% < CVR < 20%; Group C, 80% < CBF < 90% and 10% < CVR < 20%; and Group D, CBF < 90% and 20% < CVR < 30%. Patients were followed up for 2 years under best medical treatment by the stroke neurologists. Primary and secondary end points were defined as all adverse events and ipsilateral stroke recurrence respectively. A total of 132 patients were enrolled. All adverse events were observed in 9 patients (3.5%/year) and ipsilateral stroke recurrence was observed only in 2 patients (0.8%/year). There was no significant difference among the four subgroups in terms of the rate of both primary and secondary end points. Compared with the medical arm of the Japanese EC-IC bypass trial (JET) study including patients with CBF < 80% and CVR < 10% as a historical control, the incidence of ipsilateral stroke recurrence was significantly lower in the present study. Patients with symptomatic major cerebral arterial occlusive diseases and mild hemodynamic compromise have a good prognosis under medical treatment. EC-IC bypass surgery is unlikely to benefit patients with CBF > 80% or CVR > 10%.
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center.
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Kataoka
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.forename: Jyoji
authors.initials: J
authors.lastname: Nakagawara
authors.forename: Tooru
authors.initials: T
authors.lastname: Inoue
authors.forename: Etsuro
authors.initials: E
authors.lastname: Mori
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000503:physiopathology* / Q000628:therapy; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000503:physiopathology* / Q000628:therapy