Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia

摘要: Since the negative results of international Bypass Study, extracranial-intracranial (EC-IC) bypass surgery is infrequently employed in treatment patients with cerebral ischemia. Newly acquired evidence concerning pathophysiology ischemia, however, has facilitated identification a small subgroup "hemodynamic" Characteristically, these demonstrate severely impaired cerebrovascular reserve capacity due to occlusive disease and insufficient collateral blood supply. Over an 8-year period, 28 were defined by clinical laboratory criteria as suffering from hemodynamic All had recurring episodes focal ischemia unilateral internal carotid artery occlusion. Computerized tomography (CT) scans either normal or showed border zone infarction. The was studied using 133Xe single-photon emission CT acetazolamide challenge found be significantly all patients. Based on criteria, superficial temporal artery-middle anastomosis performed augment flow ischemic hemispheres. Two died myocardial infarction, one 4 days other 2 months postoperatively. One patient massive brain infarction another suffered postoperative stroke incomplete recovery, resulting major morbidity mortality rate 14%. Minor included subdural hematoma who subsequently recovered completely. course uneventful 23 (82%). mean follow-up period almost 3 years, no episode patency confirmed angiography 26 Follow-up studies (CBF) significant improvement latter while resting CBF essentially unchanged. In view findings, authors conclude that EC-IC constitutes appropriate therapy for recurrent strict selection this study.