Patients Receiving Extracranial to Intracranial Bypass for Atherosclerotic Vessel Occlusion Today Differ Significantly From the COSS Population

Abstract

A retrospective, single-center study was performed in Berlin between January 2012 and December 2019. A total of 179 patients with atherosclerotic disease (51% with unilateral internal carotid artery [ICA] occlusion; 49% with multivessel disease) had undergone extracranial to intracranial bypass for symptoms that had occurred within the previous 4 months, including recurrent minor ischemic stroke or transient ischemic attack (TIA) in 136 patients (76%), single TIA or ischemic stroke in 36 patients (20%), and hemodynamic instability in 7 patients (4%). The overall perioperative stroke, surgical complication, and 1-year ischemic or TIA event rate was 4%, 6.5%, and 6%, respectively. Patients more recently referred for flow augmentation surgery appear to experience more severe symptoms and have more severe vessel occlusion patterns than did patients reported in the COSS (carotid occlusion surgery study). A new randomized controlled trial appears warranted, considering the poor prognosis of patients with an occluded ICA and associated severe multivessel atherosclerotic cerebrovascular disease.