Efficacy and Safety of Timely Urgent Superficial Temporal Artery-to-Middle Cerebral Artery Bypass Surgery in Patients with Acute Ischemic Stroke: A Single-Institutional Prospective Study and a Pooled Analysis
- Authors
- Kim, Jang Hun; Yoon, Wonki; Kim, Chi Kyung; Roh, Haewon; Bae, Hee Jin; Kwon, Taek-Hyun; Suh, Sang-il; Oh, Kyungmi; Chong, Kyuha
- Issue Date
- 2월-2021
- Publisher
- KARGER
- Keywords
- Acute ischemic stroke; Acute stroke intervention; Acute stroke treatment; Bypass surgery; Stroke surgery
- Citation
- CEREBROVASCULAR DISEASES, v.50, no.1, pp.34 - 45
- Indexed
- SCIE
SCOPUS
- Journal Title
- CEREBROVASCULAR DISEASES
- Volume
- 50
- Number
- 1
- Start Page
- 34
- End Page
- 45
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/137791
- DOI
- 10.1159/000512106
- ISSN
- 1015-9770
- Abstract
- Background: Clinical outcome in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) is not satisfactory if reperfusion treatment fails or is not tried. Aims: We aimed to assess the efficacy and safety of urgent superficial temporal-to-middle cerebral artery (STA-MCA) bypass surgery in selected patients. Methods: Patients who were diagnosed with LVO-induced AIS in the anterior circulation but had a failed intra-arterial thrombectomy (IAT) or were not tried due to IAT contraindications were prospectively enrolled. Timely urgent STA-MCA bypass surgery was performed if they showed perfusion-diffusion mismatch or symptom-diffusion mismatch in the acute phase of disease. Clinical and radiological data of these patients were assessed to demonstrate the safety and efficacy of urgent bypass procedures. A pooled analysis of published data on urgent bypass surgery in acute stroke patients was conducted and analyzed. Results: In 18 patients who underwent timely bypass, the National Institutes of Health Stroke Scale (NIHSS) score improved from 12.11 +/- 4.84 to 9.89 +/- 6.52, 1 week after surgery. Three-month and long-term (9.72 +/- 5.00 months) favorable outcomes (modified Rankin Scale [mRS] scores 0-2) were achieved in 50 and 75% of the patients, respectively. The pooled analysis (117 patients from 10 articles, including ours) identified favorable mRS scores in 71.79% patients at 3 months. A significant NIHSS score improvement from 11.51 +/- 4.89 to 7.59 +/- 5.50 was observed after surgery with significance. Major complications occurred in 3 patients (2.6%, 3/117) without mortality. Conclusions: Urgent STA-MCA bypass surgery can be regarded as a safe optional treatment to prevent cerebral infarct expansion and to improve clinical and radiological outcomes in highly selected patients. (c) 2021 S. Karger AG, Basel
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