Are the Results of the Extracranial–Intracranial Bypass Trial Generalizable?

Barnett, H. J. M.; Sackett, David L.; Taylor, D. Wayne; Haynes, B. W.; Peerless, Sydney J.; Meissner, Irene; Hachinski, Vladimir; Aj, Fox

doi:10.1056/nejm198703263161320

Cited by 95 publications

(22 citation statements)

References 8 publications

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“…3,42 This claim was conclusively refuted by further data provided by the EC-IC Bypass Trial Investigators. 4,5 Third, critics noted that no hemodynamic criteria were used to select those high-risk patients who were most likely to benefit from revascularization. 41,51 This latter criticism was particularly germane given that ICA occlusion does not always predict cerebral hemodynamic impairment in individual patients.…”

Section: International Ec-ic Bypass Trialmentioning

confidence: 99%

Extracranial-intracranial bypass for ischemic cerebrovascular disease: what have we learned from the Carotid Occlusion Surgery Study?

Reynolds

Derdeyn

Grubb

et al. 2014

FOC

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Extracranial-intracranial (EC-IC) arterial bypass has been used in the treatment of various neurosurgical pathologies including skull base tumors requiring sacrifice of a large intracranial artery; complex intracranial aneurysms requiring trapping; and distal revascularization, moyamoya disease, and symptomatic cerebrovascular stenoocclusive disease. The latter indication has been the subject of intense investigations in several large randomized controlled trials, most recently the Carotid Occlusion Surgery Study (COSS). In the present literature review and synthesis, the authors examine the current evidence available for EC-IC arterial bypass for the treatment of ischemic cerebrovascular disease including both extracranial carotid artery occlusive disease and intracranial atherosclerotic disease. They focus particular attention on EC-IC arterial bypass for the treatment of symptomatic hemodynamic cerebral ischemia and how lessons learned from the COSS might guide future investigations into the treatment of this disease.

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Section: International Ec-ic Bypass Trialmentioning

confidence: 99%

Extracranial-intracranial bypass for ischemic cerebrovascular disease: what have we learned from the Carotid Occlusion Surgery Study?

Reynolds

Derdeyn

Grubb

et al. 2014

FOC

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“…The study investigators also pointed out that randomized trials involve only a small fraction of the population at risk and that this factor does not prevent a study from being valid. 8 Following the publication of the EC-IC bypass trial conclusions, there was a marked decrease in the number of STA-MCA bypasses performed for cerebrovascular occlusive disease. 2 Cerebral revascularization continued to be…”

Section: Cerebral Vasospasm and Sahmentioning

confidence: 99%

Superficial temporal artery to middle cerebral artery bypass: past, present, and future

Vilela

Newell

2008

FOC

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Object The aim of this study was to review the historical developments and current status of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass. Method A literature review was performed to review the origins and current uses of the STA bypass procedure in neurosurgery. Results The idea of providing additional blood supply to the brain to prevent stroke and maintain neurological function has been present in the mind of neurosurgeons for many decades. In 1967 the first STA–MCA bypass was done by M. G. Yaşargil, and an enormous step was made into the field of microneurosurgery and cerebral revascularization. During the decades that followed, this technique was used as an adjuvant or a definitive surgical treatment for occlusive disease of the extracranial and intracranial cerebral vessels, skull base tumors, aneurysms, carotid–cavernous fistulas, cerebral vasospasm, acute cerebral ischemia, and moyamoya disease. With the results of the first randomized extracranial–intracranial (EC–IC) bypass trial and the development of endovascular techniques such as angioplasty for intracranial atherosclerotic disease and cerebral vasospasm, the indications for STA–MCA bypass became limited. Neurosurgeons continued to perform EC–IC bypasses as an adjuvant to clipping of aneurysms and in the treatment of skull base tumors and moyamoya disease; the procedure is less commonly used for atherosclerotic carotid artery occlusion (CAO) with definite evidence of hemodynamic insufficiency. The evidence that patients with symptomatic CAO and “misery perfusion” have an increased stroke risk has prompted a second trial for evaluating EC–IC bypass for stroke prevention. The Carotid Occlusion Surgery Study is a new trial designed to determine whether STA–MCA bypass can reduce the incidence of stroke in these patients. New trials will also reveal the role of the STA–MCA bypass in the prevention of hemorrhages in moyamoya disease. Conclusions The role of STA–MCA bypass in the management of cerebrovascular disease continues to be refined and evaluated using advanced imaging techniques and by performing randomized trials for specific purposes, including symptomatic CAO.

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“…Reanalysis of the study data has failed to show that not considering these patients influenced the results. 6 This seemingly straightforward evaluation of a proposed treatment encountered considerable difficulty in enlisting neurosurgical departments at academic centers in the United States to join and contribute subjects to the study. Many departments were committed initially, but some later dropped out because they believed that EC/IC bypass surgery had already been proven effective and therefore should not be denied to any subject deemed suitable.…”

Section: Neurology Neurosurgery Controlled Trials and Academic Accomentioning

confidence: 99%

Neurology, neurosurgery, controlled trials and academic accountability.

McDowell¹

1988

Stroke

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Are the Results of the Extracranial–Intracranial Bypass Trial Generalizable?

Cited by 95 publications

References 8 publications

Extracranial-intracranial bypass for ischemic cerebrovascular disease: what have we learned from the Carotid Occlusion Surgery Study?

Extracranial-intracranial bypass for ischemic cerebrovascular disease: what have we learned from the Carotid Occlusion Surgery Study?

Superficial temporal artery to middle cerebral artery bypass: past, present, and future

Neurology, neurosurgery, controlled trials and academic accountability.

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