Journal of Neurosurgical Sciences 2021 Mar 11

DOI: 10.23736/S0390-5616.21.05094-3

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Bypass for flow-augmentation in atherosclerotic carotid occlusion: a review of the literature and career experience

Alfred P. SEE, Fady T. CHARBEL ✉

Department of Neurosurgery, University of Illinois at Chicago, IL, USA

Atherosclerosis of the internal carotid artery and intracranial vessels can compromise cerebral hemodynamics and cause stroke. Cerebral bypass has a half-century history in augmenting or replacing blood flow the brain. Several trials have investigated various applications of cerebral bypass in flow augmentation for atherosclerotic disease. This review discusses the clinical science of cerebrovascular atherosclerosis to provide the context in which cerebral bypass is currently applied. This includes prior clinical trials, ongoing clinical trials, and consensus guidelines, and is complemented by studies in the physiologic science of cerebrovascular flow. The scientific background is supplemented by the description of the technical art of bypass surgery based on a three-decade experience. Successful application of cerebral bypass to augment flow in atherosclerotic cerebrovascular disease requires correct diagnosis of compromised hemodynamic reserve refractory to medical optimization and an appropriate matching of bypass flow with cerebral demand.

KEY WORDS: Regional blood flow; Carotid artery diseases; Intracranial atherosclerosis; Hemodynamics; Cerebral revascularization