gms | German Medical Science

Objective: Ever since Yasargil performed the first extracranial-intracranial bypass in 1967 it has been discussed whether patients predominantly profit from this procedure. This prospectively planned and retrospectively analyzed study describes how a subgroup of patients with atherosclerotic internal carotid artery occlusion benefits from this technique. The least aim of our study was to evaluate if the number of symptomatic attacks the patients initially presented with were reduced due to the bypass.

Methods: This one-center study focuses on patients-centered care created by analyzing individual cases including patients who underwent STA-MCA bypass procedures between 06/2008 and 10/2011. Inclusion criteria: at least one symptomatic ACI occlusion dating back a minimum of 6 month measured by digital subtraction angiography (DSA); reduced or missing cerebrovascular-reserve capacity evaluated via 99mTc-HMPAO-SPECT; identification of an appropriate donor artery in the ECA circulation without the establishment of a physiological anastomosis; expected compliance during follow-up at 3, 6 (with DSA) and 12 month and the possibility of hyperbaric oxygen therapy if needed.

Results: 17 patients full-filled the inclusion criteria. The peri-operative morbidity and mortality rate were 2 and 0 patients, respectively. During follow-up including physical examination and angiography all bypasses remained patent. 6 patients experienced further cerebrovascular events including hemiparesis, retinal ischemia and other transient symptoms. All patients showed an enhancement of local perfusion in previously poorly supplied areas. A reduction in the frequency of symptoms was achieved for all patients as well as amelioration in motoric and cognitive skills as monitored by using the modified ranking scale.

Conclusions: Even though we only surveyed a small group of patients presenting with individual combinations of symptoms our study population is representative by being non-selective and therefore applicable for clinical routine. Patients with severe hemodynamic failure, missing collateral circulation and preoperatively presenting with reiterating events such as hemiparesis, TIAs etc. showed the best outcome after surgery by an improvement in symptoms and a risk-reduction for future cerebrovascular events through an increase of total brain perfusion. This leads to the conclusion that EC-IC bypass surgery is a convincing opportunity which should be considered for this selected group of patients with symptomatic ICA occlusion.