NS01 IS THERE A RESURGENCE OF CEREBRAL REVASCULARIZATION?

Since the publication in 1985 of the EC‐IC bypass study group, which demonstrated failure of EC‐IC bypass surgery to reduce stroke rate, there has been a dramatic reduction in the number of EC/IC bypass surgeries performed globally. However there have been ongoing concerns amongst neurosurgeons that the EC‐IC bypass operation still has a role, at least in selected groups of patients. These groups include, patients with Moya Moya disease, those requiring arterial sacrifice (particularly when trial occlusion demonstrates symptomatic cerebral ischaemia), and in certain patients with cerebral ischaemia in whom medical management has failed and there is a demonstrable reversible ischaemic deficit. Over the past decade there has been de‐skilling of the neurosurgical community in cerebrovascular procedures. Even those neurosurgeons who have maintained a high cerebrovascular case‐load rarely perform EC‐IC bypass surgeries. The technical demands of the procedure are such that it is difficult to maintain skill proficiency with a low case‐load. Nevertheless a few cerebrovascular surgeons at large institutions have recently noted an increase in referral of patients requiring EC‐IC bypass. Current multicentre studies are underway to re‐evaluate its role. It would seem likely that a modest increase in the demand for this surgery will occur.