Document Detail


Cerebral revascularization for ischemic disease in the 21st century.
MedLine Citation:
PMID:  21990632     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Shortly after the first extracranial to intracranial (EC-IC) carotid artery bypass was performed by Yasargil in 1967 for internal carotid artery occlusion, cerebral revascularization became widely accepted in the neurosurgical field, and the procedures became increasingly used as practitioners began to master the technical aspects of the surgery. The procedures were performed for intracranial arterial stenosis and occlusion and used as an adjunct in the treatment of large aneurysms and skull base tumors. The results of the EC-IC bypass group trial in 1985 were surprising to many and sobering to all; EC-IC bypass for stenosis or occlusion of the high internal carotid artery or middle cerebral artery did not decrease the risk of subsequent stroke compared with medical management. Rather, the incidence of stroke increased, and the events were noted to occur sooner than with medical therapy alone. Despite the known limitations of this landmark study, the number of EC-IC bypass procedures fell precipitously over the ensuing decades. Despite this significant setback, cerebral revascularization is not obsolete. This article revisits the sequence of events leading to the rise of revascularization surgery and recaps the impact of the EC-IC bypass trial. The limitations of the trial are discussed, as are current studies evaluating the efficacy of cerebrovascular bypass procedures for symptomatic carotid occlusive disease. The authors review the accepted indications for bypass surgery in the early 21st century.
Authors:
Nicholas C Bambakidis; Shakeel A Chowdhry
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurointerventional surgery     Volume:  2     ISSN:  1759-8486     ISO Abbreviation:  J Neurointerv Surg     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2011-10-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101517079     Medline TA:  J Neurointerv Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  229-36     Citation Subset:  IM    
Affiliation:
University Hospitals Case Medical Center, Cleveland, Ohio, USA.
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