Bob Hansman
runs nationially recognized City Faces program
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Bob Hansman runs nationially recognized City Faces program |
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Does brain artery bypass prevents future strokes?
By Gila Z. Reckess The School of Medicine is leading a multicenter effort to see whether brain artery bypass surgery prevents people from having a second stroke. The medical school team received a five-year, $17 million grant from the National Institute of Neurological Disorders and Stroke and now is looking for volunteers to participate. Each year, about 80,000 Americans develop complete blockage of one of the carotid arteries, the main blood vessels on each side of the neck that supply the brain with blood, resulting in either a stroke or a transient ischemic attack (a milder form of stroke). A team headed by William J. Powers, M.D., professor of neurology and neurological surgery and of radiology, and Robert L. Grubb Jr., M.D., the Herbert Lourie Professor of Neurological Surgery and professor of radiology, has been studying the best way to treat these patients to prevent another stroke. They discovered that some people develop their own natural bypasses, with smaller vessels taking over for the clogged carotid. The team found that pictures of blood flow and oxygen use in the brain taken by positron emission tomography (PET) can identify those who already have developed a natural bypass. In 1998, the team published an article in the Journal of the American Medical Association, which showed that only about 5 percent of people who developed a natural bypass had a stroke on the same side of the brain within two years, compared with more than 26 percent of people who did not develop a natural bypass. "At the moment, these people do really badly even with the best medical treatments available," Powers said. "We believe this trial is an opportunity to explore a promising alternative." Brain artery bypass surgery was developed and tested in the 1970s in patients with completely blocked carotid arteries. It was abandoned in the mid-1980s because research showed that the surgery did not always prevent future strokes, and the risks of surgery outweighed the benefits. However, it was performed on all patients at that time, whether they had developed a natural bypass or not. "Since brain surgery always has potential complications, operating on people who did not need the surgery may have clouded results from early studies," Powers said. By performing this surgery only on people who have not already developed a bypass on their own, the team will determine if the procedure's results will be more successful than the original findings in the '80s. Individuals with carotid artery blockage who have had a stroke or a transient ischemic attack within the last four months may be eligible for the study. Researchers will perform free PET brain scans of all participants. Half of the participants whose PET scans show that they have not developed a natural bypass will be randomly assigned to undergo free brain artery bypass surgery. All participants will continue medical treatment under the supervision of their primary care physician. Powers is the principal investigator of the trial, which includes 29 institutions from the United States and Canada. He and Grubb direct the clinical coordinating center for the multicenter trial, which is located at the medical school. Colin P. Derdeyn, M.D., associate professor of radiology, Ralph G. Dacey Jr., M.D., the Edith R. and Henry G. Schwartz Professor and chairman of the Department of Neurological Surgery, and Michael R. Chicoine, M.D., associate professor of neurological surgery, will care for patients who enroll in the study. For more information, contact Susanne Fritsch at 362-3466. |
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