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Ischemic Stroke ll: Pathophysiology

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...

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Updated: Jun 17, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Delayed microsurgical revascularization in an acute ischemic stroke based on perfusion study.

Jiri Dostal¹, Jan Mracek², Filip Heidenreich³

¹Department of Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic. dostalj@fnplzen.cz.

Acta Neurochirurgica

|November 1, 2023

Summary

A delayed stroke treatment involving microsurgical revascularization in a patient with a viable brain tissue showed favorable outcomes. This highlights the importance of seeking patients with severe neurological deficits for timely intervention.

Keywords:

4D CT angiography CT perfusion Carotid artery dissection Extra-intracranial bypass Intracranial atherosclerosis Large vessel occlusion

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Area of Science:

Neurosurgery
Vascular Neurology
Cerebrovascular Disease

Background:

Stroke due to internal carotid artery siphon occlusion can cause severe neurological deficits.
Standard treatments may fail, necessitating alternative therapeutic strategies.
Delayed neurosurgical consultation can impact treatment options and outcomes.

Observation:

A 58-year-old patient presented with a severe neurological deficit from left internal carotid artery siphon occlusion.
Standard treatment was ineffective, and neurosurgical consultation was delayed.
Perfusion imaging revealed viable brain tissue despite the delay.

Findings:

Microsurgical revascularization using an extra-intracranial bypass (left superficial temporal artery to left middle cerebral artery) was successfully performed 36 hours post-symptom onset.
The patient experienced a favorable outcome following the bypass surgery.
The study emphasizes identifying patients with severe deficits but viable brain tissue.

Implications:

This case suggests that extended time windows for revascularization may be feasible in selected stroke patients with viable brain tissue.
Microsurgical extra-intracranial bypass is a viable alternative treatment for complex carotid artery occlusions.
Active patient selection and consideration of alternative treatments are crucial for improving stroke outcomes.