OBJECTIVE: The 1985 International Extracranial-Intracranial (EC-IC) Bypass Trial failed to show a benefit following surgery in @entity1 with varying degrees of @entity850 . More recent studies using modern technology to identify appropriate candidates, however, have generated promising findings. As a result, controversy exists regarding the role of this technique in the treatment of symptomatic @entity432 . To this end, we performed a systematic review and quantitative analysis of the literature to determine if a subset of @entity1 with symptomatic hemodynamic failure secondary to @entity432 may benefit from direct EC-IC bypass. METHODS: We performed a MEDLINE (1985-2007) database search using the following keywords, singly and in combination: EC-IC bypass, hemodynamic failure and misery perfusion. Additional studies were identified manually by scrutinizing references from identified manuscripts, major neurosurgical journals and texts, and personal files. Our literature search divided studies into three categories: natural history of @entity1 with stage I hemodynamic failure (16 studies, 2320 @entity1 ), natural history of @entity1 with stage II hemodynamic failure (3 studies 163 @entity1 ), and outcomes of @entity1 with hemodynamic failure treated by EC-IC bypass (23 studies 506 @entity1 ). RESULTS: @entity1 with severe stage I and stage II hemodynamic failure are at higher risk of @entity385 than those with mild disease (p=.014, OR 1.17-4.08 and p=0.10, OR 0.89-3.63, respectively). Additionally, @entity1 with severe hemodynamic failure respond better to surgery than those with mild disease (p=0.03, OR 0.16-0.92). CONCLUSIONS: @entity1 with severe hemodynamic failure secondary to @entity432 appear to benefit from direct EC-IC bypass surgery. As a result, the conclusions of the 1985 International EC-IC Bypass Trial may not be applicable to this subset of @entity1 . A randomized clinical trial involving this @entity1 population is warranted.

The efficacy of direct extracranial-intracranial bypass in the treatment of symptomatic hemodynamic failure secondary to XXXX : a systematic review.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity850 :: ('MESH:D003251', 'Disease') :: ['angiographic ICA stenosis'] @entity432 :: ('MESH:D001157', 'Disease') :: ['athero-occlusive disease'] @entity385 :: ('MESH:D002544', 'Disease') :: ['cerebral infarction']
@entity432 :: (MESH:D001157,Disease) :: ['athero-occlusive disease']
