Extracranial-intracranial arterial bypass surgery for occlusive carotid artery disease

Extracranial-intracranial arterial bypass surgery in patients with symptomatic occlusive disease of carotid artery might possibly be equal to medical care alone, although the evidence is insufficient.

A Cochrane review included 21 studies with a total of 2591 patients with symptomatic carotid artery occlusive disease. Two of the trials were RCTs (n=1691). Extracranial-intracranial (EC/IC) arterial bypass surgery plus best medical treatment was compared with best medical treatment alone to prevent subsequent stroke, improve cerebral haemodynamics and reduce dependency after stroke. For all endpoints, no benefit of EC/IC bypass surgery was shown either in the RCTs (any death: OR 0.81, 95% CI 0.62 to 1.05; stroke: OR 0.99, 95% CI 0.79 to 1.23; death and dependency: OR 0.94, 95% CI 0.74 to 1.21), or in the non-RCTs (any death: OR 1.00, 95% CI 0.62 to 1.62; stroke: OR 0.80, 95% CI 0.54 to 1.18; death and dependency: OR 0.80, 95% CI 0.50 to 1.29; 19 trials, n=900).

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in patients).

Ədəbiyyat

1. Fluri F, Engelter S, Lyrer P. Extracranial-intracranial arterial bypass surgery for occlusive carotid artery disease. Cochrane Database Syst Rev 2010 Feb 17;2:CD005953.