77 - Extracranial–Intracranial Bypass for Cerebral Ischemia

Abstract

Extracranial-intracranial (EC-IC) bypass procedures performed for the treatment of ischemia are aimed at augmenting blood flow in the setting of hemodynamically significant cerebrovascular steno-occlusive disease. EC-IC bypass for flow augmentation is a well-established treatment in moyamoya disease but has a limited role in treatment of atherosclerotic occlusive disease due to evidence failing to support its role in routine management in this setting. EC-IC bypass can also be performed to replace and preserve flow in the setting of planned vessel sacrifice in order to avert cerebral ischemia; such a procedure is typically conducted for the treatment of complex aneurysms. Its role is well-accepted, though infrequently required. The indications for EC-IC bypass, patient selection, and bypass procedure are reviewed in this chapter.