Adams H P, Powers W J, Grubb R L, Clarke W R, Woolson R F
Division of Cerebrovascular Diseases, Department of Neurology, University of Iowa College of Medicine, Iowa City, Iowa 52242, USA.
Neurosurg Clin N Am. 2001 Jul;12(3):613-24, ix-x.
In 1985, the International Study of Extracranial-to-Intracranial Arterial Anastomosis demonstrated no benefit from extracranial-to-intracranial arterial bypass operations in treatment of patients with extensive cerebrovascular disease including those with occlusions of the internal carotid artery. Interest in the potential use of extracranial-to-intracranial arterial bypass operations, however, has been rekindled by evidence that some patients with occlusion of the internal carotid artery have a poor collateral circulation and a high risk for recurrent ischemic events. Other patients with adequate perfusion after occlusion have a low likelihood for recurrent stroke. Restricting surgical treatment to only those patients judged to have a high risk for recurrent stroke might improve the usefulness of the bypass operation. A new clinical trial is proposed, testing the potential usefulness of extracranial-to-intracranial arterial bypass operations for treatment of carefully selected patients with occlusion of the internal carotid artery. Several issues that are being addressed in this new trial are described in this article.
1985年，颅外-颅内动脉吻合术国际研究表明，对于包括颈内动脉闭塞患者在内的广泛脑血管疾病患者，颅外-颅内动脉搭桥手术并无益处。然而，有证据表明，一些颈内动脉闭塞患者侧支循环不良，复发性缺血事件风险高，这重新燃起了人们对颅外-颅内动脉搭桥手术潜在用途的兴趣。其他颈内动脉闭塞后灌注充足的患者复发性中风的可能性较低。将手术治疗仅限于那些被判定有复发性中风高风险的患者，可能会提高搭桥手术的效用。本文提出了一项新的临床试验，以测试颅外-颅内动脉搭桥手术对精心挑选的颈内动脉闭塞患者的潜在效用。本文描述了这项新试验中正在解决的几个问题。
