Journal article
Failure of Extracranial-Intracranial Arterial Bypass to Reduce the Risk of Ischemic Stroke: Results of an International Randomized Trial
The New England journal of medicine, Vol.313(19), pp.1191-1200
11/07/1985
DOI: 10.1056/NEJM198511073131904
PMID: 2865674
Abstract
Abstract 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, MantelHaenszel 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. (N Engl J Med 1985; 313:1191-1200.)
Details
- Title: Subtitle
- Failure of Extracranial-Intracranial Arterial Bypass to Reduce the Risk of Ischemic Stroke: Results of an International Randomized Trial
- Creators
- EC/IC Bypass Study Group
- Contributors
- Harold P Adams Jr (Contributor) - University of Iowa, Neurology
- Resource Type
- Journal article
- Publication Details
- The New England journal of medicine, Vol.313(19), pp.1191-1200
- Publisher
- Massachusetts Medical Society; Boston
- DOI
- 10.1056/NEJM198511073131904
- PMID
- 2865674
- ISSN
- 0028-4793
- eISSN
- 1533-4406
- Language
- English
- Date published
- 11/07/1985
- Academic Unit
- Neurology; Iowa Neuroscience Institute
- Record Identifier
- 9984020755102771
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