Future of extracranial-intracranial bypass

Neurol Res. 2002;24 Suppl 1:S80-3. doi: 10.1179/016164102101199954.


Total occlusion of internal carotid artery in the cervical region is an end result of progressive occlusive vascular disease. A small proportion of these patients will have symptoms of cerebral ischemia due to cerebral hypoperfusion in a delayed fashion. Identification of those individuals who are at risk of developing symptoms and prophylactically treating with a revascularization procedure will prevent such catastrophic events. With the co-operative study for bypass not supporting the bypass procedure and trial being questioned for its design and conclusions, a new trial of extracranial-intracranial bypass, The Carotid Occlusion Surgery Study, using the currently available technology will be undertaken to verify that the bypass will decrease the future stroke rate by at least 40% in patients with total carotid occlusion. A subset of patients with skull base pathology including tumors and aneurysms who may have to undergo carotid sacrifice as part of the surgical procedure are at risk of peri-operative and delayed stroke. Identification of these patients at risk by pre-operative tests may allow performance of extracranial-intracranial bypass prior to undertaking complex skull base procedures. The new imaging technology will guide management of these patients at risk and help identify patients who may need a bypass procedure.

Publication types

  • Review

MeSH terms

  • Cerebral Revascularization / trends*
  • Humans