Results of Prospective Cohort Study on Symptomatic Cerebrovascular Occlusive Disease Showing Mild Hemodynamic Compromise [Japanese Extracranial-Intracranial Bypass Trial (JET)-2 Study]

• Published in: Neurologia medico-chirurgica 2015, Vol.55(6), pp.460-468
• Main Authors: KATAOKA, Hiroharu, MIYAMOTO, Susumu, OGASAWARA, Kuniaki, IIHARA, Koji, TAKAHASHI, Jun C., NAKAGAWARA, Jyoji, INOUE, Tooru, MORI, Etsuro, OGAWA, Akira, On Behalf of the JET-2 Investigators
• Format: Article
• Language: English
• Subjects: cerebral blood flow; cerebrovascular reactivity; hemodynamic cerebral ischemia; Original; recurrence; stroke
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.oa.2014-0424

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%.