EC-IC bypass 10 years later: Is it valuable?

Caplan, Louis R.; Piepgras, David G.; Quest, Donald O.; Toole, James F.; Samson, Duke; Futrell, Nancy; Millikan, Clark H.; Flamm, Eugene S.; Heros, Roberto C.; Yonekawa, Yukihide; Eguchi, Toru; Yonas, Howard; Rothbart, David; Spetzler, Robert F.

doi:10.1016/s0090-3019(96)90802-2

Cited by 29 publications

(20 citation statements)

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“…After the EC-IC Bypass Study in 1985, 20 the use of extracranial-intracranial bypass surgery for occlusion of the ICA has been highly controversial. 21,22 A number of studies have shown that patients with an exhausted VMR are at an increased risk of cerebral ischemia. [23][24][25][26] After extracranialintracranial bypass surgery, the previously impaired cerebrovascular and oxygen metabolic reserve is normalized.…”

Section: Rohrberg and Brodhun Transcranial Doppler-co 2 Test And Levomentioning

confidence: 99%

Measurement of Vasomotor Reserve in the Transcranial Doppler-CO ₂ Test Using an Ultrasound Contrast Agent (Levovist)

Rohrberg

Brodhun

2001

Stroke

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Background and Purpose-Determination of vasomotor reserve (VMR) with the transcranial Doppler-CO 2 test is used to assess the risk of impending cerebral ischemia in patients with high-grade stenosis or occlusion of the internal carotid artery. In patients with a poor temporal window, however, this examination is limited. The aim of this study therefore was to examine whether the use of an ultrasound contrast agent (USCA) influences the results of the TCD-CO 2 test. Methods-In the first part of the study, 6 control subjects and 20 patients were examined with the TCD-CO 2 test. The VMR was determined first without the application of a contrast agent and then with continuous infusion of an USCA (Levovist, 300 mg/mL, 1 mL/min). In the second part of the study, 2 tests without USCA were performed in each of 13 patients and 2 tests with USCA infusion were performed in each of 12 patients. Statistical analysis included differences between the VMR determined with the 2 comparative measurements (⌬VMR), the mean (M⌬ VMR ), and SD. Results-Based on the mean difference, the TCD-CO 2 test produced the same results with and without USCA (M⌬ VMR 1.8%), although the differences showed a wide distribution (2 SDs, Ϯ20.7%). Similar spreads were seen in repeated determinations of VMR in the same patient without USCA (2 SDs, Ϯ20.0%), whereas the distribution under continuous USCA infusion was considerably smaller (2 SDs, Ϯ8.2%). Conclusions-The TCD-CO 2 test can be performed with continuous infusion of an USCA without influencing the results.Even with a good temporal window, the results of the TCD-CO 2 test show better reproducibility and thus better reliability if an USCA is used.

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Section: Rohrberg and Brodhun Transcranial Doppler-co 2 Test And Levomentioning

confidence: 99%

Measurement of Vasomotor Reserve in the Transcranial Doppler-CO ₂ Test Using an Ultrasound Contrast Agent (Levovist)

Rohrberg

Brodhun

2001

Stroke

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“…Extracranial-intracranial bypass has been repeatedly shown to be a useful tool in the armamentarium of the vascular neurosurgeon (3,13). Extracranial-intracranial revascularization with the STA, radial artery, or SV provides preservation of flow and demonstrates good long-term patency rates.…”

Section: Interposition Grafts and Aneurysmsmentioning

confidence: 99%

Interposition Grafts and Aneurysms

Amenta

Heros

2015

World Neurosurgery

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“…[1] Since then the operation has been largely abandoned throughout the world. [2] At this time there is no treatment of proven value for these patients other than antithrombotic medication and vigorous control of vascular risk factors. It has been suggested that the EC=IC bypass trial has failed because of inclusion of wrong patients.…”

Section: Introductionmentioning

confidence: 99%

Management of Patients With Symptomatic Carotid Artery Occlusion

Kappelle

Klijn

Tulleken

2002

Clinical and Experimental Hypertension

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The annual risk of stroke in patients with symptomatic carotid artery occlusion (CAO) and impaired cerebral blood flow (CBF) is approximately 10%. Increased oxygen extraction fraction measured by positron emission tomography (PET) and low cerebrovascular reactivity assessed by transcranial Doppler is associated with an increased risk of recurrent ischemic stroke in these patients. Recently, other risk factors have been identified: (1) symptoms of purported hemodynamic origin; (2) ongoing symptoms in the presence of documented symptomatic CAO; (3) leptomeningeal collaterals visible on angiography; and (4) low NAA/choline ratio on magnetic resonance (MR) spectroscopy. Evidence is growing that a second extracranial-intracranial (EC-IC) bypass trial might be worthwhile in patients with symptomatic CAO. Probably, only patients with ongoing symptoms and compromised CBF should be included in such a trial. Current evidence based therapeutic options for patients with symptomatic CAO include antithrombotic medication and control of vascular risk factors. For stenosis of the contralateral internal or ipsilateral external carotid artery endarterectomy may be considered. Ongoing symptoms may cease after tapering of antihypertensive medication.

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EC-IC bypass 10 years later: Is it valuable?

Cited by 29 publications

References 0 publications

Measurement of Vasomotor Reserve in the Transcranial Doppler-CO ₂ Test Using an Ultrasound Contrast Agent (Levovist)

Measurement of Vasomotor Reserve in the Transcranial Doppler-CO ₂ Test Using an Ultrasound Contrast Agent (Levovist)

Interposition Grafts and Aneurysms

Management of Patients With Symptomatic Carotid Artery Occlusion

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EC-IC bypass 10 years later: Is it valuable?

Cited by 29 publications

References 0 publications

Measurement of Vasomotor Reserve in the Transcranial Doppler-CO 2 Test Using an Ultrasound Contrast Agent (Levovist)

Measurement of Vasomotor Reserve in the Transcranial Doppler-CO 2 Test Using an Ultrasound Contrast Agent (Levovist)

Interposition Grafts and Aneurysms

Management of Patients With Symptomatic Carotid Artery Occlusion

Contact Info

Product

Resources

About

Measurement of Vasomotor Reserve in the Transcranial Doppler-CO ₂ Test Using an Ultrasound Contrast Agent (Levovist)

Measurement of Vasomotor Reserve in the Transcranial Doppler-CO ₂ Test Using an Ultrasound Contrast Agent (Levovist)