Can a patent extracranial-intracranial bypass provoke the conversion of an intracranial arterial stenosis to a symptomatic occlusion?

M. K. Gumerlock, H. Ono, Edward Neuwelt

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Although extracranial-intracranial (EC-IC) artery anastomosis seems to result in symptomatic improvement in certain types of cerebrovascular ischemic disease, this procedure can also be associated with significant morbidity, some of which paradoxically may be the direct result of a patent bypass. A review of the last 5 1/2 years at the Oregon Health Sciences University shows that 50 patients underwent 51 superficial temporal artery to middle cerebral artery bypass procedures with an angiographic patency rate of 91%. Of the 50 patients, 17 had intracranial stenotic lesions of either the middle cerebral artery (7 patients) or the internal carotid artery (10 patients). One patient had posterior cerebral artery stenosis. Five of the 18 patients with stenosis and a patent bypass developed a symptomatic occlusion of the stenotic lesion within 30 days after the anastomosis. It is hypothesized that the EC-IC bypass may have contributed to the occlusion in some of these patients by causing a change in the hemodynamic state. Possibly the bypass reversed the direction of flow distal to the stenosis to result in stasis and subsequent occlusion at the site of the stenosis or in some other manner affected hemostasis (i.e., the coagulation cascade).

Original languageEnglish (US)
Pages (from-to)391-400
Number of pages10
JournalNeurosurgery
Volume12
Issue number4
StatePublished - 1983

Fingerprint

Pathologic Constriction
Middle Cerebral Artery
Posterior Cerebral Artery
Cerebrovascular Disorders
Temporal Arteries
Internal Carotid Artery
Hemostasis
Arteries
Hemodynamics
Morbidity
Health

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Can a patent extracranial-intracranial bypass provoke the conversion of an intracranial arterial stenosis to a symptomatic occlusion? / Gumerlock, M. K.; Ono, H.; Neuwelt, Edward.

In: Neurosurgery, Vol. 12, No. 4, 1983, p. 391-400.

Research output: Contribution to journalArticle

@article{4c3afddc079d48d39e05b632ed3a451e,
title = "Can a patent extracranial-intracranial bypass provoke the conversion of an intracranial arterial stenosis to a symptomatic occlusion?",
abstract = "Although extracranial-intracranial (EC-IC) artery anastomosis seems to result in symptomatic improvement in certain types of cerebrovascular ischemic disease, this procedure can also be associated with significant morbidity, some of which paradoxically may be the direct result of a patent bypass. A review of the last 5 1/2 years at the Oregon Health Sciences University shows that 50 patients underwent 51 superficial temporal artery to middle cerebral artery bypass procedures with an angiographic patency rate of 91{\%}. Of the 50 patients, 17 had intracranial stenotic lesions of either the middle cerebral artery (7 patients) or the internal carotid artery (10 patients). One patient had posterior cerebral artery stenosis. Five of the 18 patients with stenosis and a patent bypass developed a symptomatic occlusion of the stenotic lesion within 30 days after the anastomosis. It is hypothesized that the EC-IC bypass may have contributed to the occlusion in some of these patients by causing a change in the hemodynamic state. Possibly the bypass reversed the direction of flow distal to the stenosis to result in stasis and subsequent occlusion at the site of the stenosis or in some other manner affected hemostasis (i.e., the coagulation cascade).",
author = "Gumerlock, {M. K.} and H. Ono and Edward Neuwelt",
year = "1983",
language = "English (US)",
volume = "12",
pages = "391--400",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Can a patent extracranial-intracranial bypass provoke the conversion of an intracranial arterial stenosis to a symptomatic occlusion?

AU - Gumerlock, M. K.

AU - Ono, H.

AU - Neuwelt, Edward

PY - 1983

Y1 - 1983

N2 - Although extracranial-intracranial (EC-IC) artery anastomosis seems to result in symptomatic improvement in certain types of cerebrovascular ischemic disease, this procedure can also be associated with significant morbidity, some of which paradoxically may be the direct result of a patent bypass. A review of the last 5 1/2 years at the Oregon Health Sciences University shows that 50 patients underwent 51 superficial temporal artery to middle cerebral artery bypass procedures with an angiographic patency rate of 91%. Of the 50 patients, 17 had intracranial stenotic lesions of either the middle cerebral artery (7 patients) or the internal carotid artery (10 patients). One patient had posterior cerebral artery stenosis. Five of the 18 patients with stenosis and a patent bypass developed a symptomatic occlusion of the stenotic lesion within 30 days after the anastomosis. It is hypothesized that the EC-IC bypass may have contributed to the occlusion in some of these patients by causing a change in the hemodynamic state. Possibly the bypass reversed the direction of flow distal to the stenosis to result in stasis and subsequent occlusion at the site of the stenosis or in some other manner affected hemostasis (i.e., the coagulation cascade).

AB - Although extracranial-intracranial (EC-IC) artery anastomosis seems to result in symptomatic improvement in certain types of cerebrovascular ischemic disease, this procedure can also be associated with significant morbidity, some of which paradoxically may be the direct result of a patent bypass. A review of the last 5 1/2 years at the Oregon Health Sciences University shows that 50 patients underwent 51 superficial temporal artery to middle cerebral artery bypass procedures with an angiographic patency rate of 91%. Of the 50 patients, 17 had intracranial stenotic lesions of either the middle cerebral artery (7 patients) or the internal carotid artery (10 patients). One patient had posterior cerebral artery stenosis. Five of the 18 patients with stenosis and a patent bypass developed a symptomatic occlusion of the stenotic lesion within 30 days after the anastomosis. It is hypothesized that the EC-IC bypass may have contributed to the occlusion in some of these patients by causing a change in the hemodynamic state. Possibly the bypass reversed the direction of flow distal to the stenosis to result in stasis and subsequent occlusion at the site of the stenosis or in some other manner affected hemostasis (i.e., the coagulation cascade).

UR - http://www.scopus.com/inward/record.url?scp=0020535157&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0020535157&partnerID=8YFLogxK

M3 - Article

C2 - 6856063

AN - SCOPUS:0020535157

VL - 12

SP - 391

EP - 400

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 4

ER -