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STA-MCA bypass for the treatment of ischemic stroke.

Abstract
It is considered controversial whether superficial temporal artery (STA)-middle cerebral artery (MCA) bypass affects the outcome of patients with ischemic stroke. This prospective study was undertaken to demonstrate the effect of STA-MCA bypass on the cerebral blood flow and neurological status of the patients with ischemic stroke. Seventy-five patients underwent unilateral or bilateral STA-MCA bypass surgery. The selection of the patients closely adhered to the criteria of the Japan EC-IC Bypass Trial (JET). Cerebral blood flow (CBF) before and after Diamox administration was measured by single photon emission computed tomography (SPECT) using iodine-123-N-isopropyl-p-iodoamphetamine (IMP). MRI, contrast-enhanced 3D CT scans, and angiography were performed on each patient pre- and postoperatively. Bypass surgery was successfully done in all patients. CBF was significantly increased after STA-MCA bypass (P < 0.05). In addition, reservation of CBF was significantly improved after STA-MCA bypass (P < 0.05). Patients with transient ischemic attack (TIA) did not experience recurrence of such episodes after STA-MCA bypass. The neurological deficit was unchanged in patients with complete stroke after bypass surgery. However, the NIH stroke scale was significantly improved after bypass surgery (P < 0.01). In addition, the satisfaction rate of treatment as assessed by the patients themselves was very high after STA-MCA bypass (>90%) compared to the conservative treatment group (<50%). STA-MCA bypass still plays a limited role in the treatment of ischemic stroke, but may become a bright hope in depressed patients after cerebral ischemia.
AuthorsKenji Kanamaru, Tomohiro Araki, Fumihiro Kawakita, Kazuhide Hamada, Hideki Kanamaru, Keita Matsuura, Akitoshi Sato, Hidenori Suzuki
JournalActa neurochirurgica. Supplement (Acta Neurochir Suppl) Vol. 112 Pg. 55-7 ( 2011) ISSN: 0065-1419 [Print] Austria
PMID21691988 (Publication Type: Journal Article)
Chemical References
  • Inosine Monophosphate
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Cerebral Revascularization (methods)
  • Cerebrovascular Circulation (physiology)
  • Female
  • Humans
  • Inosine Monophosphate
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stroke (diagnostic imaging, surgery)
  • Tomography, Emission-Computed, Single-Photon

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