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THE EXTRACRANIAL–INTRACRANIAL BYPASS STUDY: HOW WILL THE OUTCOME AFFECT US?
Author(s) -
DONNAN G. A.,
BLADIN P. F.,
WOODWARD J. M.
Publication year - 1985
Publication title -
australian and new zealand journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0004-8291
DOI - 10.1111/j.1445-5994.1985.tb04067.x
Subject(s) - medicine , bypass surgery , stroke (engine) , natural history , surgery , intensive care medicine , artery , mechanical engineering , engineering
Extracranial‐intracranial bypass is now a commonly performed procedure in centres with a high level of neurosurgical and vascular expertise. Bypass of surgically inaccessible stenoses or occlusions appears to be a logical technique to prevent future stroke but there is much uncertainty about the clinical indications for surgery and even the natural history of the lesions being bypassed. To answer these questions, the International EC/IC Bypass Study was set up in 1977 with relatively broad entry criteria. The data will be analysed in June 1985 and if the results support the use of bypass as a means of preventing subsequent stroke, the procedure should become firmly established. However, if the results are negative, or inconclusive, rather than discard the procedure, subsets of higher risk patients should be sought, in particular using newer methods of assessing cerebral perfusion and metabolism. (Aust NZ J Med 1985; 15: 386–391.) Summary ECAC bypass represents a remarkable technological advance and may be an important means of preventing stroke in selected individuals. It is one of the few procedures in medicine being evaluated stringently in terms of efficacy early in its development. The results of the multicentre EC/IC bypass study are being eagerly awaited around the world. If the study shows that bypass is beneficial, the procedure will become firmly established as a legitimate form of stroke prophylaxis. If the study is negative, rather than discard the procedure altogether, we should re‐examine the indications for surgery, particularly in the light of new technologies capable of sensitive assessments of cerebral perfusion and metabolism.