Effect of the extra-intracranial (STA-MCA) arterial anastomosis on EEG and cerebral blood flow: a controlled study of patients with unilateral cerebral ischemia.

Weerd, A.W. de; Veering, M.M.; Mosmans, P.C.M.; Huffelen, Alexander C. van; Tulleken, Cornelis A.F.; Jonkman, E.J.

doi:10.1161/01.str.13.5.674

Cited by 31 publications

(4 citation statements)

References 19 publications

(10 reference statements)

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“…6 [23][24][25][26][27][28][29][30][31][32] Most investigators have observed only modest rises of blood flow in a minority of patients studied, the change being often a transient phenomenon which is no longer demonstrable 3 or 4 months after the procedure.27 29 32 Some authors have suggested that a measurement of cerebral circulatory reserve, as judged by the capacity to increase blood flow in response to inhaled carbon dioxide, may be a more useful haemodynamic index than the level of blood flow itself.26 31 33 More recent studies using positron emission tomography (PET) have enabled measurements to be made not only of cerebral blood flow, but also of the metabolic demands of the brain, as reflected by regional oxygen consumption.3435 It has been shown that there are some patients with occlusive carotid artery disease in whom cerebral blood flow is inappropriately low in relation to the oxygen requirements of surviving brain.16 25 36 37 This critical haemodynamic state is characterised by a compensatory rise of fractional oxygen extraction (normally less than 50%), which maintains oxygen delivery to the tissues in the face of the reduced blood supply. A small number of patients have been reported in whom EC-IC bypass surgery was followed by restoration of blood flow and a fall to normal levels of a previously raised oxygen extraction ratio.16 25 Even when cerebral blood flow is still appropriately matched to metabolic demands, reduction of cerebral circulatory reserve may be evident as a regional increase of cerebral blood volume, consistent with focal vasodilatation in response to diminished cerebral per-fusion pressure.…”

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confidence: 99%

“…36 37 Analysis of the relationship between blood flow, blood volume and oxygen extraction has suggested that the ratio ofcerebral blood flow to blood volume (a reflection of mean flow velocity) provides a more sensitive index of cerebral perfusion pressure than either variable considered alone. 36 38 In view of the apparently minor and inconsistent effect of bypass surgery of cerebral blood flow, [23][24][25][26][27][28][29][30][31][32] this study was carried out to establish whether other physiological variables, in particular the cerebral blood volume, might provide more information about the haemodynamic effect of the procedure.…”

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confidence: 99%

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Cerebral haemodynamic changes after extracranial-intracranial bypass surgery.

Gibbs¹,

Wise²,

Thomas³

et al. 1987

Journal of Neurology, Neurosurgery & Psychiatry

127

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SUMMARY Regional cerebral blood flow, oxygen utilisation, fractional oxygen extraction, and cerebral blood volume were measured by positron emission tomography in twelve patients with carotid artery occlusion. Follow-up studies were carried out at a mean interval of eleven weeks after extracranial-intracranial bypass surgery. Clinical improvement was observed in three patients who had presented with frequent transient ischaemic attacks. One patient with multiple vascular occlusions suffered a stroke at the time of surgery. Follow-up studies showed an increase of regional cerebral blood flow in only two of the twelve patients. In the group as a whole, there was no significant change of cerebral blood flow, oxygen consumption or fractional oxygen extraction after bypass surgery. The most consistent post-operative change, observed in eleven of the twelve patients, was a fall of cerebral blood volume in the cortical territory of the bypassed carotid artery (p < 0-01). This effect was most marked in patients with bilateral carotid occlusion, in whom there was often an accompanying fall of blood volume in the contralateral hemisphere. The post-operative findings were consistent with an increase of regional cerebral perfusion pressure as a result of the bypass procedure. Although this effect is potentially of value, those patients with most to gain from bypass surgery may also run the highest risk of peri-operative cerebral ischaemia.

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confidence: 99%

mentioning

confidence: 99%

Cerebral haemodynamic changes after extracranial-intracranial bypass surgery.

Gibbs¹,

Wise²,

Thomas³

et al. 1987

Journal of Neurology, Neurosurgery & Psychiatry

127

View full text Add to dashboard Cite

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“…CBF reductions were predominantly in the middle cerebral artery distribution 28 and were consonant with reports from other laboratories. One of the earlier studies 21 did make comparison with a control group and was similar in design to the present report. Ten patients undergoing STA-MCA by-pass were compared to 10 patients treated medically.…”

mentioning

confidence: 84%

Long-term assessment of cerebral perfusion following STA-MCA by-pass in patients.

Tanahashi¹,

Meyer²,

Rogers³

et al. 1985

Stroke

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SUMMARY A prospective study of mean hemispheric cerebral blood flow (CBF) correlated with clinical status has now been completed for the past 54 months. Thirty-eight patients underwent superficial temporal to middle cerebral artery (STA-MCA) by-pass. They were compared with 22 patients with similar arteriographic lesions and clinical symptoms, treated medically throughout the same interval of time. Assignment to either treatment group was not randomized but depended solely on choice of patient or treating physician. Both groups were matched for age, clinical symptoms, angiographic abnormalities, and CBF values. All patients had proximal occlusion of one internal carotid artery or intracranial occlusive disease of the internal carotid or middle cerebral arteries. CBF measurements and clinical evaluations were repeated at regular intervals up to 54 months following surgery or institution of medical treatment. Mean follow up interval after STA-MCA by-pass was 28.7 months and for medical treatment was 29.7 months. Mean hemispheric CBF values for STA-MCA patients became significantly increased 2 weeks after operation. After that, CBF flow values decreased. At 24 months after surgery, flow values for surgically treated patients were significantly higher than among those treated medically, although there were no differences in flow values between the two groups at 3, 6,12, 36 and 48 months. Prospective clinical evaluations after STA-MCA by-pass were as follows: 12 (32%) improved with cessation of TIAs and/or neurological improvement, 16 (42%) remained unchanged, 7 (18%) deteriorated (due to new or recurrent strokes) and 3 (8%) expired. Clinical results were the same for medical treatment: 6 (27%) improved, 10 (46%) unchanged, 4 (18%) deteriorated due to new or recurrent stroke, and 2 (9%) expired.

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“…16,32 Many studies have reported improvement in cerebral hemodynamic measurements after a conventional STA-MCA bypass, 30,[33][34][35][36] but comparisons with similar patients who were not operated on are lacking. Others found that improvement in hemodynamic measures did not occur 37 or occurred in only some operated patients. 38,39 Improvement in hemodynamic measures has been shown most prominently in patients in whom such measures were most disturbed before operation.…”

Section: Klijn Et Al High-flow Ec/ic Bypass In Symptomatic Carotid Ocmentioning

confidence: 99%

Excimer Laser–Assisted High-Flow Extracranial/Intracranial Bypass in Patients With Symptomatic Carotid Artery Occlusion at High Risk of Recurrent Cerebral Ischemia

Klijn

Kappelle

Zwan

et al. 2002

Stroke

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Background and Purpose-The goal of this study was to determine safety and long-term outcome of the excimer laser-assisted high-flow extracranial/intracranial (EC/IC) bypass in patients with symptomatic carotid artery occlusion (CAO) at high risk of recurrent stroke. Methods-In a prospectively collected cohort of 103 patients with symptomatic CAO, 15 patients were selected for excimer laser-assisted EC/IC bypass surgery on the basis of predefined selection criteria: (1) transient or moderately disabling symptoms of focal cerebral ischemia, not symptoms of the retina only; (2) continuing symptoms after documentation of the CAO; (3) evidence of a possible hemodynamic origin of symptoms; and (4) informed consent of the patient. Results-Eleven patients underwent the operation without complications One patient had a severely disabling stroke (Rankin grade 4) 11 days after the operation; the bypass was found occluded on reoperation. Two other patients had a moderately disabling stroke (Rankin grade 3) immediately after the operation. One patient died of myocardial infarction 1 day after surgery. Median follow-up time was 27 months. Of the 11 patients who underwent the operation without complications, 1 died 17 months after the operation of a brainstem stroke, and another patient had a new stroke ipsilateral to his CAO 10 months after the operation but without a change in Rankin grade. Conclusions-The excimer laser-assisted high-flow EC/IC bypass operation is a potentially promising procedure in patients with symptomatic CAO and a presumably high risk of recurrent stroke, but the procedure carries a definite risk. This risk is probably related not only to the procedure itself but also to the selection of patients.

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Effect of the extra-intracranial (STA-MCA) arterial anastomosis on EEG and cerebral blood flow: a controlled study of patients with unilateral cerebral ischemia.

Cited by 31 publications

References 19 publications

Cerebral haemodynamic changes after extracranial-intracranial bypass surgery.

Cerebral haemodynamic changes after extracranial-intracranial bypass surgery.

Long-term assessment of cerebral perfusion following STA-MCA by-pass in patients.

Excimer Laser–Assisted High-Flow Extracranial/Intracranial Bypass in Patients With Symptomatic Carotid Artery Occlusion at High Risk of Recurrent Cerebral Ischemia

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