Extra-Intracranial Bypass Surgery in Patients with Hemodynamic Cerebral Ischemia

  • P. Schmiedek
  • A. Piepgras
  • G. Leinsinger
  • K. Einhäupl
  • C. M. Kirsch

Abstract

Following the publication of the result of the International Cooperative Study on Extra-Intracranial Bypass Surgery, which had failed to show any beneficial effect of this operation in reducing the risk of stroke, the indication for this procedure has been almost entirely abandoned (Bogouslavsky and Regli 1986; EC-IC Bypass Study Group 1985). It has been argued, however, that the indications previously used for bypass surgery, which were mainly based on clinical and angiographic criteria, did not take into consideration the rather complicated pathophysiology of stroke. Using positron emission tomography (PET) which allows the simultaneous measurement of cerebral blood flow (CBF), cerebral blood volume (CBV), and various parameters of brain oxygen metabolism, it is now possible to identify a particular subgroup of patients with cerebrovascular insufficiency, namely those with hemodynamic cerebral ischemia (Gibbs et al. 1984; Powers and Raichle 1985; Powers et al. 1987). According to these studies, hemodynamic cerebral ischemia may occur in patients with cerebrovascular occlusive disease with poor collaterization and is characterized by a low CBF to CBV ratio, reflecting a decreased cerebral perfusion pressure.

Keywords

Ischemia Expense Neurol Washout Acetazolamide 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bogouslavsky J, Regli F (1986) Borderzone infarctions distal to internal carotid artery occlusion: Prognostic implications. Ann Neurol 20:346–350CrossRefGoogle Scholar
  2. EC-IC Bypass Study Group (1985) Failure of extra-intracranial arterial bypass to reduce the risk of ischemic stroke. N Engl J Med 313:1191–1200CrossRefGoogle Scholar
  3. Gibbs JM, Leenders KL, Wise RJS, Jones T (1984) Evaluation of cerebral perfusion reserve in patients with carotid artery occlusion. Lancet i:310–314CrossRefGoogle Scholar
  4. Kanno L, Lassen NA (1979) Two methods for calculating cerebral blood flow from emission computed tomography of inert gas concentration. J Comput Assist Tomogr 3:71–76PubMedCrossRefGoogle Scholar
  5. Leinsinger G, Schmiedek P, Kreisig T, Einhäupl K, Bauer W, Moser E (1988) 133-Xe-DSPECT. Bedeutung der zerebrovaskularen Reservekapazität für Diagnostik und Therapie der chronischen zerebralen Ischämie. Nucl Med 27:127–134Google Scholar
  6. Powers WJ, Raichle ME (1985) Positron emission tomography and its application to the study of cerebrovascular disease in man. Stroke 16:361–376PubMedCrossRefGoogle Scholar
  7. Powers WJ, Press GA, Grubb RL, Gado M, Raichle ME (1987) The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation. Ann Intern Med 106:27–35PubMedGoogle Scholar
  8. Ringelstein EB, Sievers C, Ecker S, Schneider PA, Otis SM (1988) Noninvasive assessment of C02-induced cerebral vascular response in normal individuals and patients with internal carotid artery occlusions. Stroke 19:963–969PubMedCrossRefGoogle Scholar
  9. Rutigliano MJ, Yonas H, Johnson DW (1989) Natural history of patients with compromised cerebral reserves. J Cereb Blood Flow 9 [Suppl 609]Google Scholar
  10. Strokely EM Sveinsdottier E, Lassen NA, Rommer P (1980) A single photon dynamic computer- assisted tomograph (DCAT) for imaging brain function in multiple cross sections. J Comput Assist Tomogr 4:230–240CrossRefGoogle Scholar
  11. Vorstrup S (1988) Tomographic cerebral blood flow measurements in patients with ischemic cerebrovascular disease and evaluation of the vasodilatory capacity by the acetazolamite test. Acta Neurol Scand 77 [Suppl. 114]Google Scholar
  12. Vorstrup S, Lassen L, Henriksen O et al. (1985) CBF before and after extracranial-intracranial bypass surgery in patients with ischemic cerebrovascular disease studied with 133-Xe inhalation tomography. Stroke 16:616–626PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag, Berlin Heidelberg 1992

Authors and Affiliations

  • P. Schmiedek
  • A. Piepgras
  • G. Leinsinger
  • K. Einhäupl
  • C. M. Kirsch

There are no affiliations available

Personalised recommendations