Cerebral revascularization by EC-IC bypass in ischemic conditions of different etiologies

Abstract

Background: Even after the failure of EC-IC bypass trial, EC- IC bypass can help many patients in preventing future stroke. Here we present a case series of patients with cerebral ischemia from different etiological modes who underwent EC-IC bypass with positive end results. Methods: Patients in these cases series with TIA/stroke/recurrent stroke were evaluated clinically for the history of TIA or recurrent/hemodynamic TIA (in rest or during work) or progressive hemiparesis/aphasia/visual disturbances or sudden hemiplegia/hemiparesis/aphasia with subsequent significant (days to a week) recovery. MRI of the brain was done in ischemic protocol in all cases. To see the arterial pathology dynamic CTA was also done in all cases except one case. DSA was done in 03 cases. When clinical features, cerebral ischemia on MRI and arterial stenosis/occlusion on angiogram were concordant with each other, only then cerebral revascularization was done. After bypass, all patients were followed up regularly. All recorded data were reviewed retrospectively. Results: Total no. of cases were 08. The most common presentation was hemiparesis. Etiologies were infective thrombosis of ICA, orbital cellulitis, thrombosed giant ICA aneurysm, single & multiple vessel occlusion and MCA stenosis. High flow EC-IC bypass was done in one case. STA- MCA bypass was done in rest of the cases. All patient were ambulant with static neuro-status without new stroke till last follow up. All bypasses were patent and functioning till last follow up (clinical, Doppler/Imaging). Conclusion: In carefully selected cases cerebral revascularization in ischemic conditions can result positive outcome.