Free CME Article: Extracranial-Intracranial Bypass for Stroke

The results of the recently published Carotid Occlusion Surgery Study, which failed to show a benefit of extracranial-intracranial (EC-IC) bypass over medical therapy in patients with symptomatic hemodynamically significant carotid occlusion, have been interpreted by some as the end of the line for EC-IC bypass in the management of stroke. Despite being carefully conceived and executed, several aspects of the trial design, study population, and underlying assumptions deserve further examination to determine how best to translate these results into clinical practice. Although a general expansion of EC-IC bypass use in this population would not be supported by the trial results, a select subset of patients with medically refractory hemodynamic symptoms may well benefit from surgery performed with sufficiently low perioperative morbidity. The potential for beneficial functional or cognitive impact of revascularization also remains under investigation. Limited application and further study with an eye to future developments, rather than complete abandonment, is warranted.

From: Extracranial-Intracranial Bypass for Stroke—Is This the End of the Line or a Bump in the Road? by Amin-Hanjani et al.

Free full text access.

SANS Neurosurgery members can earn CME credits from this article.

Combining the power of neurosurgery’s most popular online learning resource with its most influential peer-reviewed journal, SANS Neurosurgery offers subscribers the resources to stay ahead in the rapidly moving field. Test your knowledge and neurosurgical decision-making skills with questions pulled from each issue of Neurosurgery. This SANS product provides users with the latest pearls and constantly evolving information from the latest scientific neurosurgery articles.

About these ads