Early versus Delayed Extracranial-Intracranial Bypass Surgery in Symptomatic Atherosclerotic Occlusion

Neurosurgery ◽  
2018 ◽  
Vol 85 (5) ◽  
pp. 656-663 ◽  
Author(s):  
Cory J Rice ◽  
Sung-Min Cho ◽  
Ather Taqui ◽  
Nina Z Moore ◽  
Alex M Witek ◽  
...  
Keyword(s):  
Bypass Surgery ◽  
Hemorrhagic Stroke ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Inclusion Criteria ◽  
Short Term ◽  
Ischemic Event ◽  
Perioperative Stroke ◽  
Tertiary Referral Center ◽  
Bypass Group

Abstract Background Clinical trials of extracranial-intracranial (EC-IC) bypass surgery studied patients in subacute and chronic stage after ischemic event. OBJECTIVE To investigate the short-term outcomes of EC-IC bypass in progressive acute ischemic stroke or recent transient ischemic attacks. Methods The study was a retrospective review at a single tertiary referral center from 2008 to 2015. Inclusion criteria consisted of EC-IC bypass within 1 yr of last ischemic symptoms ipsilateral to atherosclerotic occlusion of internal carotid or middle cerebral artery. Early bypass group who underwent surgery within 7 d of last ischemic symptoms were compared to late bypass group who underwent surgery >7 d from last ischemic symptom. The primary endpoint was perioperative ischemic or hemorrhagic stroke or intracranial hemorrhage within 7 d of surgery. Results Of 126 patients who underwent EC-IC bypass during the period, 81 patients met inclusion criteria, 69 (85%) persons had carotid artery occlusion, 7 (9%) had proximal MCA occlusion, and 5 (6%) had both. Early surgery had a 31% (9/29) perioperative stroke rate compared to 11.5% (6/52) of patients undergoing late bypass (P = .04). Of patients with acute stroke within 7 d of surgery, 41% (7/17) had perioperative stroke within 7 d (P = .07). Six of nine patients (67%) with blood pressure dependent fluctuation of neurologic symptoms had perioperative stroke (P = .049). Conclusion EC-IC bypass in setting of acute symptomatic stroke within 1 wk may confer higher risk of perioperative stroke. Patients undergoing expedited or urgent bypass for unstable or fluctuating stroke symptoms might be at highest risk for perioperative stroke.

scholarly journals Bypass Surgery for Symptomatic Common Carotid Artery Occlusion with Arterial Grafts: A Report of Five Cases

2017 ◽  
Vol 45 (2) ◽  
pp. 135-139
Author(s):  
Yasuhiro SANADA ◽  
Hisashi KUBOTA ◽  
Nobuhiro NAKAGAWA ◽  
Norihito FUKAWA ◽  
Kiyoshi TSUJI ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Common Carotid Artery ◽  
Bypass Surgery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Arterial Grafts ◽  
Common Carotid Artery Occlusion

Axilloaxillary Bypass for the Treatment of Subclavian Artery Stenosis Complicated by Bilateral Common Carotid Artery Occlusion: Technical Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 444-447 ◽  
Author(s):  
Masahiro Ogino ◽  
Masashi Nagumo ◽  
Toru Nakagawa ◽  
Masashi Nakatsukasa ◽  
Ikuro Murase
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Bypass Surgery ◽  
Left Subclavian Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Bilateral Common Carotid Artery ◽  
Common Carotid Artery Occlusion

Abstract OBJECTIVE AND IMPORTANCE We successfully treated a patient with stenosis of the left subclavian artery, complicated by bilateral common carotid artery occlusion, via axilloaxillary bypass surgery. CLINICAL PRESENTATION A 67-year-old patient with a history of hypertension and cerebral infarction underwent neck irradiation for treatment of a vocal cord tumor. Three months later, he began to experience transient tetraparesis several times per day. The blood pressure measurements for his right and left arms were different. Supratentorial blood flow was markedly low. The common carotid arteries were bilaterally occluded, and the right vertebral artery was hypoplastic. Therefore, only the left vertebral artery contributed to the patient's cerebral circulation; his left subclavian artery was severely stenotic. INTERVENTION The patient underwent axilloaxillary bypass surgery because the procedure avoids thoracotomy or sternotomy, manipulation of the carotid artery, and interruption of the vertebral artery blood flow. The patient has been free of symptoms for more than 5 years. CONCLUSION Neurosurgeons should be aware that extra-anatomic bypass surgery is an effective treatment option for selected patients with cerebral ischemia.

High-Flow Extracranial-to-Intracranial Excimer Laser–Assisted Nonocclusive Anastomosis Bypass for Symptomatic Carotid Artery Occlusion

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. 1687-1694 ◽  
Author(s):  
Tristan P.C. van Doormaal ◽  
Catharina J.M. Klijn ◽  
Perry T.C. van Doormaal ◽  
L. Jaap Kappelle ◽  
Luca Regli ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Bypass Surgery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
High Flow ◽  
Transient Ischemic Attacks ◽  
Mean Flow ◽  
Symptomatic Carotid

Abstract BACKGROUND: A high-flow bypass is theoretically more effective than a conventional low-flow bypass in preventing strokes in patients with symptomatic carotid artery occlusion and a compromised hemodynamic state of the brain. OBJECTIVE: To study the results of excimer laser-assisted nonocclusive anastomosis (ELANA) high-flow extracranial-to-intracranial (EC-IC) bypass surgery in these patients. METHODS: Between August 1998 and May 2008, 24 patients underwent ELANA EC-IC bypass surgery because of transient ischemic attacks or minor ischemic stroke associated with carotid artery occlusion. We retrospectively collected information. Follow-up data were updated by structured telephone interviews between May and September 2008. RESULTS: In all patients, the ELANA EC-IC bypass was patent at the end of surgery with a mean flow of 106 ± 41 mL/min. Within 30 days after the operation, 22 patients (92%) had no major complication, whereas 2 patients (8%) had a fatal intracerebral hemorrhage. During follow-up of a mean 4.4 ± 2.4 years, the bypass remained patent in 18 of the 22 surviving patients (82%) with a mean flow of 141 ± 59 mL/min. All patients with a patent bypass remained free of transient ischemic attacks and ischemic stroke. In 4 patients, the bypass occluded, accompanied by ipsilateral transient ischemic attacks in 2 patients, ipsilateral ischemic stroke in 1 patient, and contralateral ischemic stroke in another patient. CONCLUSION: ELANA EC-IC bypass surgery in patients with carotid artery occlusion is technically feasible and results in cessation of ongoing transient ischemic attacks and minor ischemic strokes, but carries a risk of postoperative hemorrhage.

Cerebrovascular CO2 reactivity after carotid artery occlusion

1988 ◽  
Vol 69 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Guy L. Clifton ◽  
Halcott T. Haden ◽  
John R. Taylor ◽  
Michael Sobel
Keyword(s):  
Carotid Artery ◽  
Bypass Surgery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Collateral Flow ◽  
Physiological Basis ◽  
Content Type ◽  
Normal Individuals ◽  
Cerebrovascular Co2 Reactivity ◽  
Normal Men

✓ Cerebral blood flow (CBF) was measured in 39 men at normocapnia and after 5% CO2 inhalation using the xenon-133 technique. Twenty-three patients had unilateral carotid artery occlusion with no angiographic evidence of contralateral carotid artery stenosis or ophthalmic collateral flow. Eleven of these patients had undergone extracranial-intracranial (EC-IC) bypass surgery. Sixteen age-matched normal men underwent CBF measurements at normocapnia and hypercapnia to provide control data. Mean hemispheric CBF was not different between hemispheres ipsilateral and contralateral to the carotid artery occlusion either in the patients who had undergone bypass surgery or in those with carotid artery occlusion alone. Considering all patients with carotid artery occlusion, mean CO2 reactivity was decreased in the hemisphere ipsilateral to the occlusion as compared to the contralateral hemisphere in both groups. Based on data from normal individuals, a hemispheric difference in CO2 reactivity of more than 0.94%/mm Hg PaCO2 or a global CO2 reactivity of less than 0.66%/mm Hg PaCO2 was considered abnormal for an individual patient. Six of 23 patients with carotid artery occlusion (three with an EC-IC bypass) had global or hemispheric abnormalities in CO2 reactivity. Patients with impaired CO2 reactivity were not distinguishable from other patients by neurological examination, presence of transient ischemic attacks, or evidence of infarction on computerized tomography scanning. This test was safe and simple to perform and may be a useful means of detecting impaired cerebrovascular collateral reserve capacity. If impaired CO2 reactivity after carotid artery occlusion proves to be associated with a high risk of subsequent stroke, the test would provide a physiological basis for selecting a subgroup of patients who could be helped by cerebral revascularization.

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