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Updated: May 26, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Bypass for the prevention of ischemic stroke
Ana Rodríguez-Hernández1, S Andrew Josephson, Andrew S Josephson
1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
World Neurosurgery
|December 21, 2011
Summary
Extracranial-intracranial bypass surgery for hemodynamic ischemic stroke lacks proven benefit despite low complication rates. Patient selection based on hemodynamic insufficiency is crucial, but evidence remains controversial, requiring individualized treatment decisions.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Ischemic strokes are often thromboembolic, but some stem from hemodynamic issues, potentially requiring surgical intervention.
- Extracranial-intracranial bypass techniques, including superficial temporal artery-to-middle cerebral artery (MCA) bypass, have been developed for such cases.
- The clinical indications and efficacy of these surgical procedures remain subjects of debate.
Purpose of the Study:
- To review current practices and assess the clinical indications and efficacy of bypass surgery for hemodynamic ischemic stroke.
- To examine the role of objective measures in patient selection for surgical intervention.
- To synthesize evidence from clinical trials and observational studies regarding bypass surgery outcomes.
Main Methods:
- Review of surgical series, systematic literature reviews, and randomized clinical trials.
- Evaluation of diagnostic techniques for hemodynamic insufficiency, such as xenon-enhanced computed tomography (CT) with acetazolamide challenge and positron emission tomography (PET).
- Analysis of patient selection criteria, surgical techniques, and postoperative outcomes.
Main Results:
- Bypass surgery has a reported morbidity rate under 5% and a patency rate exceeding 95%.
- The Extracranial-Intracranial Bypass Trial highlighted the importance of selecting patients based on objective hemodynamic insufficiency measures.
- Despite advancements in diagnostic techniques, randomized trials have yielded contradictory results regarding the clear benefit of bypass surgery.
Conclusions:
- Patients with athero-occlusive disease and hemodynamic insufficiency face a significant stroke risk if untreated.
- Current evidence supporting the efficacy of surgical intervention for hemodynamic ischemic stroke is insufficient.
- Individualized management decisions are necessary pending further data and consensus on the role of bypass surgery.
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