Results of prospective cohort study on symptomatic cerebrovascular occlusive disease showing mild hemodynamic compromise [Japanese extracranial-intracranial bypass trial (Jet)-2 study]

Hiroharu Kataoka, Susumu Miyamoto, Kuniaki Ogasawara, Koji Iihara, Jun C. Takahashi, Jyoji Nakagawara, Tooru Inoue, Etsuro Mori, Akira Ogawa

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

The purpose of this study is to determine the true threshold of cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) for subsequent ischemic stroke without extracranial-intracranial (EC-IC) bypass surgery in patients with hemodynamic ischemia due to symptomatic major cerebral arterial occlusive diseases. Patients were categorized based on rest CBF and CVR into four subgroups as follows: Group A, 80% < CBF < 90% and CVR < 10%; Group B, CBF < 80% and 10% < CVR < 20%; Group C, 80% < CBF < 90% and 10% < CVR < 20%; and Group D, CBF < 90% and 20% < CVR < 30%. Patients were followed up for 2 years under best medical treatment by the stroke neurologists. Primary and secondary end points were defined as all adverse events and ipsilateral stroke recurrence respectively. A total of 132 patients were enrolled. All adverse events were observed in 9 patients (3.5%/year) and ipsilateral stroke recurrence was observed only in 2 patients (0.8%/year). There was no significant difference among the four subgroups in terms of the rate of both primary and secondary end points. Compared with the medical arm of the Japanese EC-IC bypass trial (JET) study including patients with CBF < 80% and CVR < 10% as a historical control, the incidence of ipsilateral stroke recurrence was significantly lower in the present study. Patients with symptomatic major cerebral arterial occlusive diseases and mild hemodynamic compromise have a good prognosis under medical treatment. EC-IC bypass surgery is unlikely to benefit patients with CBF > 80% or CVR > 10%.

Original languageEnglish
Pages (from-to)460-468
Number of pages9
JournalNeurologia medico-chirurgica
Volume55
Issue number6
DOIs
Publication statusPublished - 2015

Keywords

  • Cerebral blood flow
  • Cerebrovascular reactivity
  • Hemodynamic cerebral ischemia
  • Recurrence
  • Stroke

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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