Document Detail


Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. The EC/IC Bypass Study Group.
MedLine Citation:
PMID:  2865674     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To determine whether bypass surgery would benefit patients with symptomatic atherosclerotic disease of the internal carotid artery, we studied 1377 patients with recent hemisphere strokes, retinal infarction, or transient ischemic attacks who had atherosclerotic narrowing or occlusion of the ipsilateral internal carotid or middle cerebral artery. Of these, 714 were randomly assigned to the best medical care, and 663 to the same regimen with the addition of bypass surgery joining the superficial temporal artery and the middle cerebral artery. The patients were followed for an average of 55.8 months. Thirty-day surgical mortality and major stroke morbidity rates were 0.6 and 2.5 per cent, respectively. The postoperative bypass patency rate was 96 per cent. Nonfatal and fatal stroke occurred both more frequently and earlier in the patients operated on. Secondary survival analyses comparing the two groups for major strokes and all deaths, for all strokes and all deaths, and for ipsilateral ischemic strokes demonstrated a similar lack of benefit from surgery. Separate analyses in patients with different angiographic lesions did not identify a subgroup with any benefit from surgery. Two important subgroups of patients fared substantially worse in the surgical group: those with severe middle-cerebral-artery stenosis (n = 109, Mantel-Haenszel chi-square = 4.74), and those with persistence of ischemic symptoms after an internal-carotid-artery occlusion had been demonstrated (n = 287, chi-square = 4.04). This study thus failed to confirm the hypothesis that extracranial-intracranial anastomosis is effective in preventing cerebral ischemia in patients with atherosclerotic arterial disease in the carotid and middle cerebral arteries.
Authors:
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The New England journal of medicine     Volume:  313     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1985 Nov 
Date Detail:
Created Date:  1985-11-26     Completed Date:  1985-11-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1191-200     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Brain Ischemia / mortality,  prevention & control,  surgery*
Carotid Artery Diseases / surgery
Carotid Artery, Internal / surgery
Cerebral Revascularization*
Clinical Trials as Topic
Female
Follow-Up Studies
Humans
Intracranial Arteriosclerosis / surgery
Ischemic Attack, Transient / surgery
Male
Middle Aged
Random Allocation
Recurrence
Temporal Arteries / surgery
Grant Support
ID/Acronym/Agency:
R01 NS 14164/NS/NINDS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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