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Long-term mortality and stroke morbidity after superficial temporal artery-middle cerebral artery bypass operation
Abstract:
Among 239 patients with transient ischemic attacks, mild stroke, or transient monocular visual symptoms who had superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass, no deaths occurred during the operation or within 30 days thereafter. After the first month, mortality on an actuarial basis was 3% per year. Survival at 5 years was 84% in comparison with an expected survival of 89% for persons of comparable age and sex in a general population. Among the 25 deaths that occurred during follow-up, 2 were due to stroke and 16 to cardiac causes. Of 28 strokes that occurred, 5 occurred during operation or that same day, and 3 others occurred within 30 days postoperatively. Thereafter, strokes occurred at the rate of 2.5% per year on an actuarial basis; a third of the strokes occurred contralateral to the surgical site. No difference was found in survival or in survival free of stroke among patients who had proven carotid artery occlusion (N = 157), carotid siphon stenosis (N = 53), or MCA stenosis or occlusion (N = 29). In regard to the probability of stroke, this group of patients compares favorably with population studies of patients with transient ischemic attacks of undetermined cause. When this surgical group was compared with 130 nonsurgical patients who had had ischemic symptoms related to proven internal carotid artery occlusion between 1965 and 1975, however, we could not conclude that the risk of occurrence of stroke was less in patients who had STA-MCA bypass than in the nonsurgical patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass surgery showed no perioperative deaths. While long-term survival was slightly lower than the general population, the procedure demonstrated a favorable stroke probability compared to some patient groups.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Transient ischemic attacks (TIAs) and mild strokes pose significant risks.
- Superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass is a surgical option for specific cerebrovascular conditions.
- Evaluating the long-term outcomes of STA-MCA bypass is crucial for patient management.
Purpose of the Study:
- To assess the safety and efficacy of STA-MCA bypass in patients with TIAs, mild stroke, or transient monocular visual symptoms.
- To compare the survival and stroke rates of patients undergoing STA-MCA bypass with expected population survival and other patient cohorts.
- To investigate the impact of different underlying cerebrovascular conditions (carotid occlusion, siphon stenosis, MCA stenosis/occlusion) on STA-MCA bypass outcomes.
Main Methods:
- A retrospective analysis of 239 patients who underwent STA-MCA bypass surgery.
- Actuarial analysis of mortality and stroke occurrence rates during and after the follow-up period.
- Comparison of survival rates with age- and sex-matched general population data.
- Comparison of stroke risk with non-surgical patients with internal carotid artery occlusion.
Main Results:
- No deaths occurred during or within 30 days of STA-MCA bypass surgery.
- Five-year survival was 84%, slightly lower than the expected 89% for the general population.
- The annual mortality rate after the first month was 3%, with cardiac causes being the most frequent.
- 28 strokes occurred postoperatively, with 2.5% occurring annually after the initial 30-day period.
- No significant difference in survival or stroke-free survival was observed across different underlying cerebrovascular pathologies (carotid occlusion, siphon stenosis, MCA stenosis/occlusion).
- The stroke probability in the surgical group compared favorably with population studies of TIAs of undetermined cause, but not with non-surgical patients with internal carotid artery occlusion.
Conclusions:
- STA-MCA bypass is a safe procedure with no perioperative mortality.
- Long-term survival after STA-MCA bypass is comparable to the general population, though slightly lower.
- The procedure demonstrates a potentially favorable stroke risk profile for certain patient subgroups, but further comparison with non-surgical cohorts is warranted.
- Underlying cerebrovascular disease severity did not significantly impact outcomes in this surgical cohort.