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Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
[Emergency Superficial Temporal Artery-Middle Cerebral Artery Bypass for Atherosclerotic Ischemic Stroke]
Toshiichi Watanabe1, Toshiaki Osato, Kaori Honjo
1Department of Neurosurgery, Nakamura Memorial Hospital.
Insights
Emergency superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery can effectively treat progressive atherosclerotic stroke when endovascular methods fail. This procedure significantly improves patient mobility and neurological outcomes, offering a viable treatment option for severe cases.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Stroke Medicine
Background:
- Endovascular recanalization is the standard for acute embolic stroke but often fails with atherosclerotic occlusions.
- Medical therapy alone may be insufficient for progressive cerebral infarction due to atherosclerosis.
- Atherosclerotic stroke poses unique challenges requiring alternative treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of emergency superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in patients with progressive atherosclerotic stroke.
- To determine the functional outcomes and safety of urgent STA-MCA bypass in selected cases.
- To assess the potential of STA-MCA bypass as an alternative to medical management in challenging stroke cases.
Main Methods:
- Retrospective analysis of 35 patients undergoing urgent STA-MCA bypass between 2014 and 2020.
- Inclusion criteria: atherosclerotic infarction, cerebral blood flow < 70% of contralateral side, worsening symptoms despite medical treatment, and surgery within 72 hours of onset.
- Assessment of gait independence, National Institutes of Health Stroke Scale (NIHSS) scores, and modified Rankin Scale (mRS) scores.
Main Results:
- 27 out of 35 patients (77.1%) achieved gait independence post-surgery.
- Median NIHSS scores improved from 8 preoperatively to 3 at discharge.
- Median mRS scores improved from 5 preoperatively to 2 at discharge.
- No cases of intracerebral hemorrhage due to hyper-perfusion syndrome were reported.
Conclusions:
- Emergency STA-MCA bypass is a safe and effective treatment for carefully selected patients with progressive atherosclerotic stroke.
- The procedure significantly improves functional outcomes, including gait independence and neurological scores.
- STA-MCA bypass offers a valuable therapeutic option when endovascular recanalization is not feasible or has failed.
Abstract:
Endovascular recanalization is the primary strategy for the treatment of acute embolic stroke. However, atherosclerotic occlusions are often challenging to recanalize, and only medical therapy can be performed. In these cases, even the best medical treatment may not be effective, and the cerebral infarction progressively worsens. We believe that an emergency superficial temporal artery-middle cerebral artery(STA-MCA)bypass could be effective in these situations, after careful case selection. We use the following eligibility criteria: (1)atherosclerotic infarction; (2)cerebral ischemia with blood flow < 70% of the contralateral side; (3)progressively worsening symptoms or widening of the subcortical infarction despite medical treatment; and(4)surgery availability < 72 h from symptom onset. Among the 35 patients who underwent urgent STA-MCA bypass from 2014 to 2020, 27(77.1%)gained gait independence, and the National Institutes of Health Stroke Scale(NIHSS)scores improved from a preoperative median of 8 to 3 at discharge. The modified Rankin score(mRS)improved from a preoperative median of 5 to 2 at discharge. No intracerebral hemorrhages occurred due to hyper-perfusion syndrome. When we match it with other reports, this emergency surgery allows 76-90% of patients with progressive stroke to achieve gait independency.
