Emergency STA-MCA bypass surgery for symptomatic progressive ischemic stroke

Abstract

BackgroundIntravascular acute thrombectomy is recommended for acute cerebral infarction within 8 h of onset, based on several randomized controlled trials. However, standard treatment for cases outside these indications has not been established. ObjectiveEmergent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed within 72 h of onset for non-cardiogenic cerebral artery occlusive disease and the surgical outcomes are discussed. MethodsRetrospective review of 18 consecutive patients with non-cardiac cerebrovascular occlusive stroke who underwent emergent bypass surgery from September 2010 to August 2018. Surgical indications were determined as symptomatic ICA or MCA occlusive disease within 8–72 h after onset, and crescendo and/or progressive frequent transient ischemic attack, or impending stroke despite aggressive medical treatment with National Institutes of Health Stroke Scale (NIHSS) at 4 points or more, small cortical infarction (1/3 or less), and observed perfusion-diffusion mismatch. ResultsSurgical outcome was good recovery in 2 patients, moderate disability in 8, severe disability in 6, and death in 2 patients. Favorable outcome was achieved in 55.6%, and poor outcome in 44.4%. No patient showed enlargement of the area of cerebral infarction. The value of the BRS significantly improved after surgery in favourable outcome group. No patient suffered any complication related to surgical intervention including hemorrhagic complications. ConclusionsEmergent STA-MCA bypass surgery can improve clinical outcome and reduce the risk of morbidity under strict surgical indications, so could be an option for acute stage revascularization after ineffective thrombolytic therapy for non-cardiac acute cerebrovascular stroke.