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What is Extracranial-Intracranial (EC-IC) Bypass Surgery?

To improve blood supply to the brain, an extracranial-intracranial bypass operation is performed. It entails rerouting blood flow via a total blockage from the outside to the inside of your brain.

During an extracranial-intracranial bypass (EC-IC), a new channel is made by surgeons to connect an internal carotid artery branch to an exterior carotid artery branch. These blood veins may be connected by a donor or a graft from another area of your body.

It is currently only carried out in a few centres across the globe and is regarded as an experimental therapy.

Discover more about EC-IC bypasses in the sections that follow, including the diseases they are used to treat and what happens during the surgery.


EC-IC bypass purpose

If one of your two internal carotid arteries is completely blocked, an EC-IC bypass is performed to increase blood flow to the brain. It is done to lower your chance of having a stroke in the future.

Each side of your neck has one internal carotid artery. They are one of the two pairs of arteries that feed blood to your brain, the other being your vertebral arteries.

Specifically, physicians may suggest an EC-IC bypass for the following reasons:
  • whole internal carotid artery obstruction brought on by plaque accumulation
  • avoiding a carotid artery aneurysm within
  • Moyamoya disease is a degenerative condition that causes the carotid artery to narrow.
  • damage to blood vessels caused by the excision of a tumour or an arteriovenous malformation


EC-IC bypass side effects and risks

There are dangers associated with any surgery, including EC-IC bypass. Possible issues consist of:
  • brain swelling
  • blood clots
  • reaction to anesthesia
  • infection
  • seizures
  • subdural hematoma
  • leakage of cerebral spinal fluid
  • bleeding
signs of brain injury include the following:
  • speech difficulty
  • coma
  • memory problems
  • issues with coordination or balance
In a 2023 study, 86 patients undergoing non-emergency EC-IC bypass had no problems that resulted in long-term neurological damage. This brief case review was completed at an extremely specialised facility.


What is the success rate of EC-IC bypass?

In the same 2023 study, researchers discovered that in patients exhibiting symptoms from plaque accumulation, nonemergency EC-IC bypass may be a practical therapy option for treating significant internal carotid artery constriction.

According to a 2019 study, individuals with decreased brain blood flow who received EC-IC had a five-fold lower risk of stroke, brain haemorrhage, or mortality in the 30 days following surgery.

On the other hand, in a different 2023 study, researchers discovered that in 309 patients treated for internal or middle carotid artery blockage, EC-IC did not lower the incidence of stroke or death after 30 days.

Those who underwent surgery had a 30-day risk of stroke or death of 6.2%, while those who did not have surgery had a risk of 1.8%. Those who underwent surgery had a 2% risk of having an ischemic stroke on the same side between 30 days and 2 years, while those who did not had a 10.3% risk.

Decades of literature have been devoted to debating the viability of EC-IC bypass, and at this point, most people agree that further research is necessary.


EC-IC bypass procedure

An overview of what to anticipate both before and after an EC-IC bypass is provided here.

Before EC-IC bypass

Before your operation, you will have a meeting with your surgical team, during which they will go over the plan and answer any questions you may have. Also, you'll have examinations to gauge your general and mental well-being, including:
  • cerebral angiography
  • electrocardiogram
  • blood tests
  • a physical exam
  • echocardiogram


During EC-IC bypass

Here's a general overview of what to anticipate:
  1. Through an IV, usually inserted into your hand or arm, you will receive general anaesthesia.
  2. Your external carotid artery branch will be accessed by your surgeon through an incision made close to your ear. To join this branch, they might have to cut a blood vessel from another area of your body.
  3. A craniotomy, or the removal of a portion of your skull to reveal your brain, will be performed by your surgeon. A portion of your scalp will be removed when they make an incision. They will next make incisions through the tissues that surround your brain to expose it.
  4. After the blockage in your internal carotid artery, your surgeon will join the branch of your external carotid artery.
  5. The section of bone that was removed will be rejoined to your artery and a blood vessel in your brain. Your skin will be stitched up, and bandages will be applied to your wounds.

How long does EC-IC bypass surgery take?

An intensive procedure that necessitates a craniotomy is an EC-IC. A craniotomy can take up to 5.5 hours, but it typically takes about 2.5 hours.

After EC-IC bypass

After your operation, you will awaken in the recovery area. Machines to track your vital signs and an IV will likely be attached to you. To assist the wound drain, you can also have a tube connected to it and a catheter tied to your bladder.

After a craniotomy, you should anticipate spending five to ten days in the hospital.


Preparing for EC-IC bypass surgery

You will receive detailed instructions from your doctor on how to get ready for your procedure. You will not be permitted to consume any food or liquids for at least six hours before your procedure, and maybe up to two hours. Observe the precise guidelines that your surgeon has provided you.

To lower your chance of complications, your surgeon would probably advise you to quit smoking before your procedure if you smoke.


Recovering from EC-IC bypass

Following a craniotomy, recovery may take six to twelve weeks. Until your surgeon gives the all-clear to resume flying, you will not be permitted to operate a motor vehicle during this period. It's advised to stay away from contact sports following any kind of brain surgery.


Are there any alternatives to EC-IC bypass?

Sometimes medicine alone is enough to treat carotid artery narrowing. Additional surgical procedures consist of:
  • carotid stenting
  • carotid angioplasty
  • carotid endarterectomy


How much does EC-IC bypass cost?

Your location of residence and the complexity of the process will affect the cost. According to estimates from the nonprofit organisation FAIR Health, in Denver, Colorado, 80% of head artery connection surgeries come in under $16,919 for those without insurance. Anaesthesia might cost an additional $8,407.

It's possible that your insurance won't pay for it. When used to treat carotid or middle cerebral artery stenosis, Medicare does not pay for the procedure.



Takeaway

One kind of surgery called EC-IC is performed to increase blood flow to the brain. If your brain-supplying internal carotid artery is completely blocked, it might be advised. It can also be applied to a blockage brought on by the moyamoya illness.

Since EC-IC is a significant surgery, your doctor can help you understand the possible advantages and disadvantages. Additionally, they can advise you on whether surgery would be a better course of action.




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