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Published in: Neuroradiology 9/2004

01-09-2004 | Diagnostic Neuroradiology

Extracranial–intracranial arterial bypass surgery improves total brain blood supply in selected symptomatic patients with unilateral internal carotid artery occlusion and insufficient collateralization

Authors: K. W. Neff, P. Horn, D. Dinter, P. Vajkoczy, P. Schmiedek, C. Düber

Published in: Neuroradiology | Issue 9/2004

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Abstract

It remains controversial whether extracranial–intracranial (EC–IC) arterial bypass surgery leads to a significant increase in brain blood supply, allowing the reversal of regional cerebral hypoperfusion in symptomatic patients with occlusive cerebrovascular disease and hemodynamic impairment. The aim of the present study was to determine the effects of EC–IC bypass surgery on cerebral brain-supplying blood volume flow (BVF; ml/min) from a purely hemodynamic point of view, using 2D cine phase-contrast MR imaging. Twenty-five patients with symptomatic, unilateral internal carotid artery (ICA) occlusion and hemodynamic compromise received EC–IC arterial bypass surgery. All patients underwent quantitative BVF measurements of brain-supplying arteries preoperatively and postoperatively, including the direct BVF measurement in the established EC–IC bypass after surgery. Preoperatively, total brain BVF was reduced in comparison to normal controls (595±89 vs 663±49 ml/min; [mean±SEM]; p=0.039). Mean BVF through the EC–IC bypass reached 84±32 ml/min (range: 14–177 ml/min), leading to a significant net increase in total BVF of 78±43 ml/min (range: 7–136 ml/min) when compared with BVF prior to surgery (p<0.001), with resulting postoperative BVF reaching values obtained in normal controls. EC–IC arterial bypass surgery increases total brain blood supply, allowing restoration of local perfusion in hemodynamically compromised brain tissue in patients with symptomatic ICA occlusion.
Literature
1.
go back to reference Powers WJ, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Grubb RL Jr (2000) Benign prognosis of never-symptomatic carotid occlusion. Neurology 54:878–882PubMed Powers WJ, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Grubb RL Jr (2000) Benign prognosis of never-symptomatic carotid occlusion. Neurology 54:878–882PubMed
2.
go back to reference Grubb RL Jr, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Spitznagel EL, Powers WJ (1998) Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion [see comments]. JAMA 280:1055–1060CrossRefPubMed Grubb RL Jr, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Spitznagel EL, Powers WJ (1998) Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion [see comments]. JAMA 280:1055–1060CrossRefPubMed
3.
go back to reference Derdeyn CP, Yundt KD, Videen TO, Carpenter DA, Grubb RL, Jr, Powers WJ (1998) Increased oxygen extraction fraction is associated with prior ischemic events in patients with carotid occlusion. Stroke 29:754–758PubMed Derdeyn CP, Yundt KD, Videen TO, Carpenter DA, Grubb RL, Jr, Powers WJ (1998) Increased oxygen extraction fraction is associated with prior ischemic events in patients with carotid occlusion. Stroke 29:754–758PubMed
4.
go back to reference Yamauchi H, Fukuyama H, Nagahama Y, Nabatame H, Ueno M, Nishizawa S, Konishi J, Shio H (1999) Significance of increased oxygen extraction fraction in five-year prognosis of major cerebral arterial occlusive diseases. J Nucl Med 40:1992–1998PubMed Yamauchi H, Fukuyama H, Nagahama Y, Nabatame H, Ueno M, Nishizawa S, Konishi J, Shio H (1999) Significance of increased oxygen extraction fraction in five-year prognosis of major cerebral arterial occlusive diseases. J Nucl Med 40:1992–1998PubMed
5.
go back to reference Yonas H, Smith HA, Durham SR, Pentheny SL, Johnson DW (1993) Increased stroke risk predicted by compromised cerebral blood flow reactivity. J Neurosurg 79:483–489PubMed Yonas H, Smith HA, Durham SR, Pentheny SL, Johnson DW (1993) Increased stroke risk predicted by compromised cerebral blood flow reactivity. J Neurosurg 79:483–489PubMed
6.
go back to reference Ishikawa T, Houkin K, Abe H, Isobe M, Kamiyama H (1995) Cerebral haemodynamics and long-term prognosis after extracranial-intracranial bypass surgery. J Neurol Neurosurg Psychiatry 59:625–628PubMed Ishikawa T, Houkin K, Abe H, Isobe M, Kamiyama H (1995) Cerebral haemodynamics and long-term prognosis after extracranial-intracranial bypass surgery. J Neurol Neurosurg Psychiatry 59:625–628PubMed
7.
go back to reference Klijn CJ, Kappelle LJ, Tulleken CA, van Gijn J (1997) Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors [see comments]. Stroke 28:2084–2093PubMed Klijn CJ, Kappelle LJ, Tulleken CA, van Gijn J (1997) Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors [see comments]. Stroke 28:2084–2093PubMed
8.
go back to reference Piepgras A, Leinsinger G, Kirsch CM, Schmiedek P (1994) STA-MCA bypass in bilateral carotid artery occlusion: clinical results and long-term effect on cerebrovascular reserve capacity. Neurol Res 16:104–107PubMed Piepgras A, Leinsinger G, Kirsch CM, Schmiedek P (1994) STA-MCA bypass in bilateral carotid artery occlusion: clinical results and long-term effect on cerebrovascular reserve capacity. Neurol Res 16:104–107PubMed
9.
go back to reference Tsuchida C, Kimura H, Sadato N, Tsuchida T, Tokuriki Y, Yonekura Y (2000) Evaluation of brain metabolism in steno-occlusive carotid artery disease by proton MR spectroscopy: a correlative study with oxygen metabolism by PET [see comments]. J Nucl Med 41:1357–1362PubMed Tsuchida C, Kimura H, Sadato N, Tsuchida T, Tokuriki Y, Yonekura Y (2000) Evaluation of brain metabolism in steno-occlusive carotid artery disease by proton MR spectroscopy: a correlative study with oxygen metabolism by PET [see comments]. J Nucl Med 41:1357–1362PubMed
10.
go back to reference van der Grond J, Balm R, Kappelle LJ, Eikelboom BC, Mali WP (1995) Cerebral metabolism of patients with stenosis or occlusion of the internal carotid artery. A 1H-MR spectroscopic imaging study. Stroke 26:822–828PubMed van der Grond J, Balm R, Kappelle LJ, Eikelboom BC, Mali WP (1995) Cerebral metabolism of patients with stenosis or occlusion of the internal carotid artery. A 1H-MR spectroscopic imaging study. Stroke 26:822–828PubMed
11.
go back to reference The EC-IC bypass study group (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. N Engl J Med 313:1191–1200PubMed The EC-IC bypass study group (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. N Engl J Med 313:1191–1200PubMed
12.
go back to reference Ausman JI, Diaz FG (1986) Critique of the extracranial-intracranial bypass study. Surg Neurol 26:218–222CrossRefPubMed Ausman JI, Diaz FG (1986) Critique of the extracranial-intracranial bypass study. Surg Neurol 26:218–222CrossRefPubMed
13.
go back to reference Day LD, Rhoton AL, Little JR (1986) The extracranial-intracranial bypass study. Surg Neurol 26:222–226CrossRefPubMed Day LD, Rhoton AL, Little JR (1986) The extracranial-intracranial bypass study. Surg Neurol 26:222–226CrossRefPubMed
14.
go back to reference Gilsbach JM (1983) Intraoperative Doppler sonography in neurosurgery. Springer, Berlin Heidelberg New York Gilsbach JM (1983) Intraoperative Doppler sonography in neurosurgery. Springer, Berlin Heidelberg New York
15.
go back to reference Spetzler RF, Chater N (1976) Microvascular bypass surgery. Part 2: Physiological studies. J Neurosurg 45:508–513PubMed Spetzler RF, Chater N (1976) Microvascular bypass surgery. Part 2: Physiological studies. J Neurosurg 45:508–513PubMed
16.
go back to reference Sekhar L, Kalavakonda C (1999) Saphenous vein and radial artery grafts in the management of skull base tumors and aneurysms. In: Spetzler RF, Schmiedek P (eds) Operative techniques in neurosurgery, extra-intracranial bypass surgery, vol 2. Saunders, Philadelphia, pp 129–141 Sekhar L, Kalavakonda C (1999) Saphenous vein and radial artery grafts in the management of skull base tumors and aneurysms. In: Spetzler RF, Schmiedek P (eds) Operative techniques in neurosurgery, extra-intracranial bypass surgery, vol 2. Saunders, Philadelphia, pp 129–141
17.
go back to reference van der Zwan A, Tulleken CA, Hillen B (2001) Flow quantification of the non-occlusive excimer laser-assisted EC-IC bypass. Acta Neurochir (Wien) 143:647–654 van der Zwan A, Tulleken CA, Hillen B (2001) Flow quantification of the non-occlusive excimer laser-assisted EC-IC bypass. Acta Neurochir (Wien) 143:647–654
18.
go back to reference Takagi Y, Hashimoto N, Iwama T, Hayashida K (1997) Improvement of oxygen metabolic reserve after extracranial-intracranial bypass surgery in patients with severe haemodynamic insufficiency. Acta Neurochir (Wien) 139:52–56; discussion 56–57 Takagi Y, Hashimoto N, Iwama T, Hayashida K (1997) Improvement of oxygen metabolic reserve after extracranial-intracranial bypass surgery in patients with severe haemodynamic insufficiency. Acta Neurochir (Wien) 139:52–56; discussion 56–57
19.
go back to reference Gibbs JM, Wise RJ, Thomas DJ, Mansfield AO, Russell RW (1987) Cerebral haemodynamic changes after extracranial-intracranial bypass surgery. J Neurol Neurosurg Psychiatry 50:140–150PubMed Gibbs JM, Wise RJ, Thomas DJ, Mansfield AO, Russell RW (1987) Cerebral haemodynamic changes after extracranial-intracranial bypass surgery. J Neurol Neurosurg Psychiatry 50:140–150PubMed
20.
go back to reference Powers WJ, Martin WR, Herscovitch P, Raichle ME, Grubb RL Jr (1984) Extracranial-intracranial bypass surgery: hemodynamic and metabolic effects. Neurology 34:1168–1174PubMed Powers WJ, Martin WR, Herscovitch P, Raichle ME, Grubb RL Jr (1984) Extracranial-intracranial bypass surgery: hemodynamic and metabolic effects. Neurology 34:1168–1174PubMed
21.
go back to reference Kobayashi H, Kitai R, Ido K, Kabuto M, Handa Y, Kubota T, Yonekura Y (1999) Hemodynamic and metabolic changes following cerebral revascularization in patients with cerebral occlusive diseases. Neurol Res 21:153–160PubMed Kobayashi H, Kitai R, Ido K, Kabuto M, Handa Y, Kubota T, Yonekura Y (1999) Hemodynamic and metabolic changes following cerebral revascularization in patients with cerebral occlusive diseases. Neurol Res 21:153–160PubMed
22.
go back to reference Yamashita T, Kashiwagi S, Nakano S, Takasago T, Abiko S, Shiroyama Y, Hayashi M, Ito H (1991) The effect of EC-IC bypass surgery on resting cerebral blood flow and cerebrovascular reserve capacity studied with stable XE-CT and acetazolamide test. Neuroradiology 33:217–222PubMed Yamashita T, Kashiwagi S, Nakano S, Takasago T, Abiko S, Shiroyama Y, Hayashi M, Ito H (1991) The effect of EC-IC bypass surgery on resting cerebral blood flow and cerebrovascular reserve capacity studied with stable XE-CT and acetazolamide test. Neuroradiology 33:217–222PubMed
23.
go back to reference Holzschuh M, Brawanski A, Ullrich W, Meixensberger J (1991) Cerebral blood flow and cerebrovascular reserve 5 years after EC-IC bypass. Neurosurg Rev 14:275–278PubMed Holzschuh M, Brawanski A, Ullrich W, Meixensberger J (1991) Cerebral blood flow and cerebrovascular reserve 5 years after EC-IC bypass. Neurosurg Rev 14:275–278PubMed
24.
go back to reference Schmiedek P, Piepgras A, Leinsinger G, Kirsch CM, Einheupl K (1994) Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg 81:236–244PubMed Schmiedek P, Piepgras A, Leinsinger G, Kirsch CM, Einheupl K (1994) Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg 81:236–244PubMed
25.
go back to reference Vorstrup S, Brun B, Lassen NA (1986) Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery. Stroke 17:1291–1298PubMed Vorstrup S, Brun B, Lassen NA (1986) Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery. Stroke 17:1291–1298PubMed
26.
go back to reference Yasargil MG (1967) Experimental small vessel surgery in the dog including patching and grafting of cerebral vessels and the formation of functional extra-intracranial shunts. In: Donaghy RMP, Yasargil MG (eds) Micro-vascular surgery. Georg Thieme Verlag, Stuttgart, Germany, pp 87–126 Yasargil MG (1967) Experimental small vessel surgery in the dog including patching and grafting of cerebral vessels and the formation of functional extra-intracranial shunts. In: Donaghy RMP, Yasargil MG (eds) Micro-vascular surgery. Georg Thieme Verlag, Stuttgart, Germany, pp 87–126
27.
go back to reference Vajkoczy P, Horn P, Schmiedek P (1999) Standard superficial temporal artery–middle cerebral artery bypass surgery in hemodynamic cerebral ischemia: indication and technique. Oper Techn Neurosurg 2:106–116 Vajkoczy P, Horn P, Schmiedek P (1999) Standard superficial temporal artery–middle cerebral artery bypass surgery in hemodynamic cerebral ischemia: indication and technique. Oper Techn Neurosurg 2:106–116
28.
go back to reference Macchi C, Catini C, Federico C, Gulisano M, Pacini P, Cecchi F, Corcos L, Brizzi E (1996) Magnetic resonance angiographic evaluation of circulus arteriosus cerebri (circle of Willis): a morphologic study in 100 human healthy subjects. Ital J Anat Embryol 101:115–123PubMed Macchi C, Catini C, Federico C, Gulisano M, Pacini P, Cecchi F, Corcos L, Brizzi E (1996) Magnetic resonance angiographic evaluation of circulus arteriosus cerebri (circle of Willis): a morphologic study in 100 human healthy subjects. Ital J Anat Embryol 101:115–123PubMed
29.
go back to reference Derdeyn CP, Shaibani A, Moran CJ, Cross DT 3rd, Grubb RL Jr, Powers WJ (1999) Lack of correlation between pattern of collateralization and misery perfusion in patients with carotid occlusion. Stroke 30:1025–1032PubMed Derdeyn CP, Shaibani A, Moran CJ, Cross DT 3rd, Grubb RL Jr, Powers WJ (1999) Lack of correlation between pattern of collateralization and misery perfusion in patients with carotid occlusion. Stroke 30:1025–1032PubMed
30.
go back to reference Klijn CJ, Kappelle LJ, van Der Grond J, Algra A, Tulleken CA, van Gijn J (2000) Magnetic resonance techniques for the identification of patients with symptomatic carotid artery occlusion at high risk of cerebral ischemic events. Stroke 31:3001–3007PubMed Klijn CJ, Kappelle LJ, van Der Grond J, Algra A, Tulleken CA, van Gijn J (2000) Magnetic resonance techniques for the identification of patients with symptomatic carotid artery occlusion at high risk of cerebral ischemic events. Stroke 31:3001–3007PubMed
31.
go back to reference van Everdingen KJ, Klijn CJ, Kappelle LJ, Mali WP, van der Grond J (1997) MRA flow quantification in patients with a symptomatic internal carotid artery occlusion. The Dutch EC-IC Bypass Study Group. Stroke 28:1595–1600PubMed van Everdingen KJ, Klijn CJ, Kappelle LJ, Mali WP, van der Grond J (1997) MRA flow quantification in patients with a symptomatic internal carotid artery occlusion. The Dutch EC-IC Bypass Study Group. Stroke 28:1595–1600PubMed
32.
go back to reference Adams HP Jr, Powers WJ, Grubb RL Jr, Clarke WR, Woolson RF (2001) Preview of a new trial of extracranial-to-intracranial arterial anastomosis: the carotid occlusion surgery study. Neurosurg Clin N Am 12:613–624PubMed Adams HP Jr, Powers WJ, Grubb RL Jr, Clarke WR, Woolson RF (2001) Preview of a new trial of extracranial-to-intracranial arterial anastomosis: the carotid occlusion surgery study. Neurosurg Clin N Am 12:613–624PubMed
Metadata
Title
Extracranial–intracranial arterial bypass surgery improves total brain blood supply in selected symptomatic patients with unilateral internal carotid artery occlusion and insufficient collateralization
Authors
K. W. Neff
P. Horn
D. Dinter
P. Vajkoczy
P. Schmiedek
C. Düber
Publication date
01-09-2004
Publisher
Springer-Verlag
Published in
Neuroradiology / Issue 9/2004
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-004-1252-9

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