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Updated: Oct 29, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Efficacy and Safety of Emergency Extracranial-Intracranial Bypass for Revascularization within 24 Hours in Resolving
Yun Ho Noh1, Jae Woo Chung2, Jung Ho Ko2
1Department of Neurosurgery, Soonchunhyang University, College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea.
Insights
Emergency extracranial-intracranial (EC-IC) bypass surgery shows promise for acute ischemic stroke when endovascular treatment (EVT) fails. This procedure improved outcomes and reduced infarct size in patients with intracranial atherosclerosis.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Endovascular treatment (EVT) is often less effective for acute ischemic stroke caused by intracranial atherosclerosis and emergent large vessel occlusion.
- Extracranial-intracranial (EC-IC) bypass surgery offers a potential alternative to improve cerebral blood flow in affected areas.
Purpose of the Study:
- To compare the efficacy and safety of EC-IC bypass surgery against EVT and maximal medical treatment (MMT) for acute ischemic stroke.
- To evaluate EC-IC bypass as a treatment for intracranial atherosclerosis-induced stroke where EVT is insufficient.
Main Methods:
- Retrospective analysis of 39 patients who failed revascularization despite mechanical thrombectomy.
- Patient groups included percutaneous transluminal angioplasty/stenting (PTA/S), emergency EC-IC bypass surgery (within 24 hours), and MMT.
- Evaluated vessel patency, perfusion status, infarct volume, and 6-month modified Rankin Scale (mRS) scores.
Main Results:
- EC-IC bypass had a longer reperfusion time (14.9 hours) compared to PTA/S (4.1 hours) and MMT (7.5 hours).
- Emergency EC-IC bypass resulted in significantly lower postoperative infarct volume (11.3 cm³ ) than MMT (68.0 cm³ ), comparable to PTA/S (14.0 cm³ ).
- A higher proportion of EC-IC bypass patients achieved mRS scores of 0-2 at 6 months (80%) versus PTA/S (59%) and MMT (14%).
Conclusions:
- Emergency EC-IC bypass surgery is an effective and safe treatment for acute ischemic stroke secondary to intracranial atherosclerosis when EVT is inadequate.
- EC-IC bypass surgery demonstrates significant clinical benefits in functional outcomes for selected stroke patients.
Background:
Endovascular treatment (EVT) is less effective for intracranial atherosclerosis-induced emergent large vessel occlusion. Extracranial-intracranial (EC-IC) bypass surgery is a possible treatment option to augment cerebral blood flow in the perfusion defect area. We compared the efficacy and safety of EC-IC bypass surgery with those of EVT and maximal medical treatment for acute ischemic stroke.
Methods:
The data from 39 patients, for whom vessel revascularization had failed despite mechanical thrombectomy, were retrospectively analyzed. Of the 39 patients, 22 had undergone percutaneous transluminal angioplasty or intracranial stenting (PTA/S), 10 had undergone emergency EC-IC bypass surgery within 24 hours of symptom onset, and 7 had received maximal medical treatment (MMT) only. The patency, perfusion status, and postoperative infarct volume were evaluated. The clinical outcomes were assessed at 6 months postoperatively using the modified Rankin scale.
Results:
The mean reperfusion time was significantly longer for the EC-IC bypass group (14.9 hours) compared with that in the PTA/S group (4.1 hours) and MMT group (7.5 hours; P < 0.05). The postoperative infarct volume on diffusion-weighted magnetic resonance imaging was significantly lower in the emergency EC-IC bypass group (11.3 cm3) than in the MMT group (68.0 cm3) but was not significantly different from that of the PTA/S group (14.0 cm3; P < 0.05). The proportion of patients with a modified Rankin scale score of 0-2 at 6 months after surgery was significantly higher in the EC-IC bypass group (80%) than in the PTA/S (59%) and MMT (14%) groups (P < 0.05).
Conclusions:
Emergency EC-IC bypass surgery is an effective and safe treatment option for intracranial atherosclerosis-induced acute ischemic stroke for which EVT is inadequate.
