gms | German Medical Science

Objective: This study was designed to investigate whether bypass surgery was effective for ischemic stroke prevention. After the publication of a randomized controlled study in the United States in 1985, the EC-IC bypass for ischemic stroke has decreased. Recently, the Japan EC-IC bypass study (JET study) has proved that bypass surgery is still superior to medical treatment in the stroke prevention if patients were strictly selected according to their cerebral blood flow (CBF). We have also been using bypass operations for ischemic stroke patients not only with EC-IC bypass but OA-PICA and so on, depending on the lesions and in this study we will present the summary of these cases.

Methods: CBF measurements by SPECT were performed on ischemic stroke patients, who had major vessel occlusion (or stenosis), and those who had severe ischemia (CBF at rest was under 80% of normal average value and vascular reserve was under 10%) became surgical candidates. As a result, bypass surgery was performed in 84 patients between 2002 and 2005. Bypass includes STA-MCA anastomosis (78 cases), OA-PICA anastomosis (4 cases) and ITA (internal thoracic artery)-VA (vertebral artery) anastomosis (2 cases). During surgery, the proper recipient arteries were chosen according to the 3D-SSP analyses of SPECT data, so that bypass flow compensated the more severe ischemic lesions. Bypass patency, patient's outcome and surgical complications were analyzed.

Results: Bypass patency was 94% and post-operative stroke occurred in 2 cases (average observation period: 23.7 months). Surgical morbidity and mortality were 7% and 1%, respectively. Patency was lower in cases of moyamoya disease and bleeding complications were observed in 5 cases (intracerebral hemorrhage: 3 cases, subdural hematoma: 2 cases) and epidural abscess in 1 case.

Conclusions: Bypass surgery is still effective for ischemic stroke, if the candidates are strictly selected. Technical aspects of each bypass is also be presented in the Video.