Abstract
Extracranial-intracranial (EC/IC) arterial bypass surgery is a valuable therapeutic modality in the field of cerebrovascular surgery. The assessment of bypass patency and its functional parameters are of utmost importance in the postoperative course. The present study examined the potential role of quantitative MR-based volume flow measurement techniques for the investigation of bypass patency. Forty-one patients with steno-occlusive cerebrovascular disease treated with EC/IC bypass surgery underwent conventional angiographic (CA) and two-dimensional cine-phase MR-based angiographic assessment (MRA) of bypass function. CA bypass function was evaluated as poor (grade I), moderate (grade II), or extensive (grade III) and was compared with quantitative volume flow measurements (BVF) obtained in MRA studies. Bypass filling was classified as grade I in 15% of the cases, grade II and grade III in 36% and 49% of the studies, respectively. Mean BVF differed significantly in the different grades: 31.9±9.8 ml/min in grade I, 73.6±16.7 ml/min in grade II, and 97.2±26.6 ml/min in grade III. BVF values of48 ml/min or lower ( n =6) were specific for grade I bypass function, while only BVF values higher than 111 ml/min (3/20, 15%) are specific for extensive angiographic bypass function. The assessment of EC/IC bypass patency with quantitative BVF measurements provides exact, investigator-independent information under physiological conditions. MRA is well correlated with the angiographic bypass grading system.
Similar content being viewed by others
References
Peerless SJ (1986) Indications for the extracranial-intracranial arterial bypass in light of the EC-IC Bypass Study. Clin Neurosurg 33:307–326
Nussbaum ES, Erickson DL (2000) Extracranial-intracranial bypass for ischemic cerebrovascular disease refractory to maximal medical therapy. Neurosurgery 46:37–42
Schmiedek P, Piepgras A, Leinsinger G, Kirsch CM, Einhupl K (1994) Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass surgery in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg 81:236–244
Takagi Y, Hashimoto N, Iwama T, Hayashida K (1997) Improvement of oxygen metabolic reserve after extracranial-intracranial bypass surgery in patients with severe haemodynamic insufficiency. Acta Neurochir (Wien) 139:52–56
Yonas H (1997) Predictability of extracranial/intracranial bypass function: a retrospective study of patients with occlusive cerebrovascular disease. Neurosurgery 41:1447–1448
Weinstein PR, Rodriguez y Baena R, Chater NL (1984) Results of extracranial-intracranial arterial bypass for intracranial internal carotid artery stenosis: review of 105 cases. Neurosurgery 15:787–794
Batjer H,Samson D (1986) Use of extracranial-intracranial bypass in the management of symptomatic vasospasm. Neurosurgery 19:235–246
Moritake K, Handa H, Yonekawa Y, Nagata I (1980) Ultrasonic Doppler assessment of hemodynamics in superficial temporal artery-middle cerebral artery anastomosis. Surg Neurol 13:249–257
Ausman JI (1978) Correlation of noninvasive Doppler and angiographic evaluation of extracranial-intracranial anastomoses. Surg Forum 29:534–535
Benzel EC, Kessler CW (1987) Angiography following extracranial-intracranial bypass surgery. Surg Neurol 27:585–586
Iwama T, Hashimoto N, Takagi Y, Tsukahara T, Hayashida K (1997) Predictability of extracranial/intracranial bypass function: a retrospective study of patients with occlusive cerebrovascular disease. Neurosurgery 40:53–59
Latchaw RE, Ausman JI, Lee MC (1979) Superficial temporal-middle cerebral artery bypass. A detailed analysis of multiple pre- and postoperative angiograms in 40 consecutive patients. J Neurosurg 51:455–465
Hankey GJ, Warlow CP, Molyneux AJ (1990) Complications of cerebral angiography for patients with mild carotid territory ischaemia being considered for carotid endarterectomy. J Neurol Neurosurg Psychiatry 53:542–548
Kodama T, Ueda T, Suzuki Y, Yano T, Watanabe K (1993) MRA in the evaluation of EC-IC bypass patency. J Comput Assist Tomogr 17:922–926
Kodoma T, Suzuki Y, Yano T, Watanabe K, Ueda T, Asada K (1995) Phase-contrast MRA in the evaluation of EC-IC bypass patency. Clin Radiol 50:459–465
Praharaj SS, Coulthard A, Gholkar A, English P, Mendelow AD (1996) Magnetic resonance angiographic assessment after extracranial-intracranial bypass surgery. J Neurol Neurosurg Psychiatry 60:439–441
Macchi C, Catini C, Federico C, Gulisano M, Pacini P, Cecchi F, Corcos L, Brizzi E (1996) Magnetic resonance angiographic evaluation of circulus arteriosus cerebri (circle of Willis): a morphologic study in 100 human healthy subjects. Ital J Anat Embryol 101:115–123
Everdingen KJ van , Visser GH, Klijn CJ, Kappelle LJ, van der Grond J (1998) Role of collateral flow on cerebral hemodynamics in patients with unilateral internal carotid artery occlusion. Ann Neurol 44:167–176
Everdingen KJ van , Klijn CJ, Kappelle LJ, Mali WP, van der Grond J (1997) MRA flow quantification in patients with a symptomatic internal carotid artery occlusion. The Dutch EC-IC Bypass Study Group. Stroke 28:1595–1600
Everdingen KJ van, Visser GH, Klijn CJ, Kappelle LJ, van der Grond J (1998) Role of collateral flow on cerebral hemodynamics in patients with unilateral internal carotid artery occlusion. Ann Neurol 44:167–176
Rutgers DR, Blankensteijn JD, van Der Grond J (2000) Preoperative MRA flow quantification in CEA patients: flow differences between patients who develop cerebral Ischemia and patients who do not develop cerebral ischemia during cross-clamping of the carotid artery. Stroke 31:3021–3028
Vorstrup S, Brun B, Lassen NA (1986) Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery. Stroke 17:1291–1298
Yasargil MG. Yonekawa Y (1977) Results of microsurgical extra-intracranial arterial bypass in the treatment of cerebral ischemia. Neurosurgery 1:22–24
Vajkoczy P, Hubner U, Horn P, Bauhuf C, Thome C, Schilling L, Schmiedek P, Quintel M, Thomas JE (2000) Intrathecal sodium nitroprusside improves cerebral blood flow and oxygenation in refractory cerebral vasospasm and ischemia in humans. Stroke 31:1195–1197
International Cooperative Study of Extracranial/Intracranial Arterial Anastomosis (EC/IC Bypass Study) (1985) Methodology and entry characteristics. The EC/IC Bypass Study Group. Stroke 16:397–406
Ausman JI, Diaz FG (1986) Critique of the extracranial-intracranial bypass study. Surg Neurol 26:218–221
Gibbs JM, Wise RJ, Thomas DJ, Mansfield AO, Russell RW (1987) Cerebral haemodynamic changes after extracranial-intracranial bypass surgery. J Neurol Neurosurg Psychiatry 50:140–150
Yamanaka R, Satoh S, and Kawasaki S (1988) Changes in cerebral hemodynamics after extracranial-intracranial bypass. Neurol Med Chir (Tokyo) 28:981–985
Caplan LR, Piepgras DG, Quest DO, Toole JF, Samson D, Futrell N, Millikan C, Flamm ES, Heros RC, Yonekawa Y, Eguchi T, Yonas H, Rothbart D, Spetzler RF (1996) EC-IC bypass 10 years later: is it valuable? Surg Neurol 46:416–4423
Schmiedek P (1989) EC-IC bypass in hemodynamic cerebrovascular disease. J Neurosurg 71:464–466
Vorstrup S, Haase J, Waldemar G, Andersen A, Schmidt J, Paulson OB (1996) EC-IC bypass in patients with chronic hemodynamic insufficiency. Acta Neurol Scand Suppl 166:79–81
Yonas H, Smith HA, Durham SR, Pentheny SL, Johnson DW (1993) Increased stroke risk predicted by compromised cerebral blood flow reactivity. J Neurosurg 79:483–489
Awad IA. Spetzler RF (1986) Extracranial-intracranial bypass surgery: a critical analysis in light of the International Cooperative Study. Neurosurgery 19:655–664
Webster MW, Makaroun MS, Steed DL, Smith HA, Johnson DW, Yonas H (1995) Compromised cerebral blood flow reactivity is a predictor of stroke in patients with symptomatic carotid artery occlusive disease. J Vasc Surg 21:338–344
Rhodes RS, Spetzler RF, Roski RA (1981) Improved neurologic function after cerebrovascular accident with extracranial-intracranial arterial bypass. Surgery 90:433–438
Piepgras A, Leinsinger G, Kirsch CM, Schmiedek P (1994) STA-MCA bypass in bilateral carotid artery occlusion: clinical results and long-term effect on cerebrovascular reserve capacity. Neurol Res 16:104–107
Muraishi K, Kameyama M, Sato K, Sirane R, Ogawa A, Yoshimoto T, Hatazawa J, Itoh M (1993) Cerebral circulatory and metabolic changes following EC/IC bypass surgery in cerebral occlusive diseases. Neurol Res 15:97–103
Tsuda Y, Kimura K, Iwata Y, Hayakawa T, Etani H, Fukunaga R, Yoneda S, Abe H (1984) Improvement of cerebral blood flow and/or CO2 reactivity after superficial temporal artery-middle cerebral artery bypass in patients with transient ischemic attacks and watershed-zone infarctions. Surg Neurol 22:595–604
Vorstrup S, Lassen NA, Henriksen L, Haase J, Lindewald H, Boysen G, Paulson OB (1985) CBF before and after extracranial-intracranial bypass surgery in patients with ischemic cerebrovascular disease studied with 133Xe-inhalation tomography. Stroke 16:616–626
Jack CR, Sundt TM, Fode NC, Gehring DG (1988) Superficial temporal-middle cerebral artery bypass: clinical pre- and postoperative angiographic correlation. J Neurosurg 69:46–51
Bradac GB, Schramm J, Kaernbach A, Oppel F (1980) Angiographic aspects of extra-intracranial arterial bypass (EIAB) for cerebral arterial occlusive disease. Neuroradiology 20:111–122
Little JR, Yamamoto YL, Feindel W, Meyer E, Hodge CP (1979) Superficial temporal artery to middle cerebral artery anastomosis. Intraoperative evaluation by fluorescein angiography and xenon-133 clearance. J Neurosurg 50:560–569
Spetzler R, Chater N (1976) Microvascular bypass surgery. II. Physiological studies. J Neurosurg 45:508–513
Sekhar LN, Bucur SD, Bank WO, Wright DC (1999) Venous and arterial bypass grafts for difficult tumors, aneurysms, and occlusive vascular lesions: evolution of surgical treatment and improved graft results. Neurosurgery 44:1207–1223
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Horn, P., Vajkoczy, P., Schmiedek, P. et al. Evaluation of extracranial-intracranial arterial bypass function with magnetic resonance angiography. Neuroradiology 46, 723–729 (2004). https://doi.org/10.1007/s00234-004-1249-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-004-1249-4