Abstract | BACKGROUND: Surgical reperfusion may be beneficial in patients with acute ischemic stroke who are ineligible for thrombolysis. OBJECTIVE: METHODS: The clinical and radiological data of 9 patients treated by STA-MCA bypass requiring urgent reperfusion but ineligible for intra-arterial thrombolysis (IAT) were reviewed. Pooled analysis was performed of published literature concerning STA-MCA bypass in acute stroke (21 cases in 2 articles). RESULTS: Of the 9 patients enrolled, symptom aggravation occurred during medical treatment in 4 patients and after IAT in 2. Three patients were ineligible for IAT despite being within 8 hours of symptom onset. Bypass significantly improved National Institutes of Health Stroke Scale scores (preoperatively, 12.4±4.88; 3 days postoperatively, 8.6±6.39, P=.046; discharge, 5.4±5.15, P=.008; 3 mo postoperatively 3.7±4.82, P=.008) without significant infarction growth by diffusion weighted imaging (preoperatively, 15.0±8.87 mL; 7 days postoperatively, 15.2±8.28 mL; P=.110). Abnormal perfusion regions (mean transit time>145% of contralateral side value) were reduced in all cases (2.63±0.93 mL). Good outcomes (modified Rankin scale≤2) were achieved by 6 patients. Pooled analysis with our patients showed a significant neurological improvement (P<.001) and a good outcome in 25 (83.3%) patients without hemorrhage or complication. CONCLUSION:
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Authors | Gyojun Hwang, Chang Wan Oh, Jae Seung Bang, Cheol Kyu Jung, O-Ki Kwon, Jeong Eun Kim, Hee-Jun Bae, Moon-Koo Han |
Journal | Neurosurgery
(Neurosurgery)
Vol. 68
Issue 3
Pg. 723-9; discussion 729-30
(Mar 2011)
ISSN: 1524-4040 [Electronic] United States |
PMID | 21311299
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Acute Disease
- Adult
- Aged
- Anastomosis, Surgical
(methods)
- Female
- Humans
- Ischemic Attack, Transient
(diagnosis, surgery)
- Male
- Middle Aged
- Middle Cerebral Artery
(surgery)
- Temporal Arteries
(surgery)
- Treatment Outcome
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