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Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
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Superficial Temporal Artery-to-Middle Cerebral Artery Bypass in Ischemic Stroke With Blood Pressure-Dependent

Brendan Huang1, Calvin Huang1, Khaled Alok2

  • 1Neurology, Northwell Health, Manhasset, USA.

Cureus
|April 15, 2024
PubMed

Insights

Extracranial-intracranial (EC-IC) bypass may benefit select stroke patients. CT perfusion imaging can identify patients with persistent perfusion deficits and blood pressure-dependent symptoms who may be ideal candidates for this procedure.

Area of Science:

  • Neurosurgery
  • Neurology
  • Vascular Surgery

Background:

  • The effectiveness of extracranial-intracranial (EC-IC) bypass surgery for preventing ischemic stroke is debated.
  • Current theories suggest EC-IC bypass is most effective for patients with persistent hemodynamic insufficiency.
  • Existing methods for assessing hemodynamic insufficiency, such as SPECT imaging and TCD, are time-consuming and resource-intensive.

Observation:

  • A patient with severe aphasia and right hemiparesis due to middle cerebral artery (MCA) occlusion, unresponsive to thrombectomy, presented with blood pressure-dependent symptoms.
  • CT perfusion (CTP) imaging revealed a significant area of delayed perfusion without a core infarct upon admission.
  • The patient underwent a superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass.

Findings:

  • Following the STA-MCA bypass, the patient's neurological status significantly improved, with their National Institute of Health Stroke Scale (NIHSS) score decreasing from 12 to 1.
  • CTP imaging demonstrated a reduction in the ischemic penumbra after the bypass surgery.
  • The patient's blood pressure-dependent neurological deficits resolved post-operatively.

Implications:

  • This case highlights the potential utility of EC-IC bypass in specific stroke scenarios.
  • Persistent delayed perfusion on CTP imaging and blood pressure-dependent neurological deficits may serve as valuable criteria for selecting patients for EC-IC bypass.
  • Further research is warranted to validate these findings and refine patient selection for EC-IC bypass surgery.

Keywords:
ct brain perfusionec-ic bypassintracranial atherosclerosisischemic strokenihss scoresta-mca bypass

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