Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Augmentation of the Patency of an Extracranial-Intracranial Bypass Accompanied by the Occlusion of an Intracranial Stenotic Lesion

  • Lee, Jae-Hyun (Department of Neurosurgery, Chonnam National University Hospital & Medical School) ;
  • Joo, Sung-Pil (Department of Neurosurgery, Chonnam National University Hospital & Medical School) ;
  • Lee, Jung-Kil (Department of Neurosurgery, Chonnam National University Hospital & Medical School) ;
  • Kim, Tae-Sun (Department of Neurosurgery, Chonnam National University Hospital & Medical School)
  • Published : 2007.03.30
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Abstract

We describe a case that showed augmention of the superficial temporal artery [STA] pedicle's patency 15 months after extracranial to intracranial [EC-IC] bypass surgery for a carotid artery occlusion with contralateral intracranial internal carotid artery stenosis. It is rare that meager patency of the STA pedicle in the early postoperative angiogram can be become well augmented with time where most branches of the middle cerebral artery [MCA] are robustly filled with blood from the STA. A 28-year-old woman with a history of a previous left hemispheric stroke presented with slurred speech after several bouts of seizure. Magnetic resonance imaging showed a new infarct on the right hemisphere in addition to an old infarct on the left hemisphere. Carotid angiography revealed stenosis of the right carotid siphon and occlusion of the left carotid artery. The patient underwent EC-IC bypass on the right side. Even though the early postoperative angiogram showed meager filling of MCA with no significant stenotic lesion change, a subsequent angiogram taken 15 months later, demonstrated a widely patent STA pedicle with occlusion of the previous intracranial stenotic lesion. Selected cases with an inaccessible intracranial stenotic lesion can benefit from EC-IC bypass surgery; however, its clear indication should first be established.

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References

  1. Ausman JI, Diaz FG : Critique of the extracranial-intracranial bypass study. Surg Neurol 26 : 218-221, 1986 https://doi.org/10.1016/0090-3019(86)90152-7
  2. Awad IA, Furlan AJ, Little JR : Changes in intracranial stenotic lesions after extracranial-intracranial bypass surgery. J Neurosurg 60 : 771-776, 1984 https://doi.org/10.3171/jns.1984.60.4.0771
  3. Awad IA, Spetzler RF : Extracranial-intracranial bypass surgery : a critical analysis in light of the international cooperative study. Neurosurgery 19 : 655-664, 1986 https://doi.org/10.1227/00006123-198610000-00028
  4. Bauer RB, Boulos RS, Meyer JS : Natural history and surgical treatment of occlusive cerebrovascular disease evaluated by serial arteriography. AJR 104 : 1-17, 1968 https://doi.org/10.2214/ajr.104.1.1
  5. Day AL, Rhoton AL Jr, Little JR : The Extracranial-intracranial bypass study. Surg Neurol 26 : 222-226, 1986 https://doi.org/10.1016/0090-3019(86)90153-9
  6. Goldring S, Zervas N, Langfitt T : The extracranial-intracranial bypass study. A report of the committee appointed by the American Association of Neurological Surgeons to examine the study. N Engl J Med 316 : 817- 820, 1987 https://doi.org/10.1056/NEJM198703263161319
  7. Grubb RL Jr, Powers WJ : Risks of stroke and current indications for cerebral revascularization in patients with carotid occlusion. Neurosurg Clin N Am 12 : 473-487, 2001
  8. Gumerlock MK, Ono H, Neuwelt EA : Can a patient extracranial-intracranial bypass provoke the conversion of an intracranial arterial stenosis to a symptomatic occlusion? Neurosurgery 12 : 391-400, 1983 https://doi.org/10.1227/00006123-198304000-00004
  9. Link MJ, Herzog GA : Extracranial- Intracranial Bypass -Technical achievement, controversies and indications in the treatment of ischemic stroke. Jacksonville medicine 49 : 505-509, 1998
  10. Moon KY, Kang SD, Kim YS : Transcranial Doppler examination following EIAB in patients with hemodynamic cerebral ischemia. J Korean Neurosurg Soc 35 : 273-277, 2004
  11. Nussbaum ES, Erickson DL : Extracranial- Intracranial bypass for ischemic cerebrovascular disease refractory to maximal medical therapy. Neurosurgery 46 : 37-43, 2000 https://doi.org/10.1093/neurosurgery/46.1.37
  12. Schmiedek P, Piepgras A, Leinsinger G, Kirsch CM, Einhaupl K : Improvement of cardiovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic ischemia. J Neurosurg 81 : 236-244, 1994 https://doi.org/10.3171/jns.1994.81.2.0236
  13. Sundt TM Jr : Was the international randomized trial of extracranialintracranial arterial bypass representative of the population at risk? N Engl J Med 316 : 814-816, 1987 https://doi.org/10.1056/NEJM198703263161318
  14. The EC/IC Bypass Study Group : Failure of extracranial- intracranial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313 : 1191-2000, 1985 https://doi.org/10.1056/NEJM198511073131904
  15. Weinstein PR, Baena RR, Chater NL : Results of extracranial-intracranial arterial bypass for intracranial internal carotid artery stenosis : review of 105 cases. Neurosurgery 15 : 787-794, 1984 https://doi.org/10.1227/00006123-198412000-00003