Toshikazu Kimura1, Yasumitsu Ichikawa2, Tomohiro Inoue3. 1. Department of Neurosurgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. tkim-tky@umin.ac.jp. 2. Department of Neurology, Tokuyama Central Hospital, Yamaguchi, Japan. 3. Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan.
Abstract
BACKGROUND: Intravenous recombinant tissue-type plasminogen activator (rt-PA) with/without endovascular treatment is sometimes not ideally effective for the treatment of acute hemodynamic stroke due to atherosclerotic major artery steno-occlusive disease, and some patients show fluctuation in or progression of symptoms despite intensive medical therapy. Urgent superficial temporal artery-middle cerebral artery (STA-MCA) bypass has been reported to be effective in patients with progressing stroke. OBJECTIVE: To investigate the efficacy of urgent STA-MCA bypass performed at a single institution for progressing stroke due to hemodynamic compromise caused by atherosclerosis. METHOD: We retrospectively reviewed clinical and operative records. Neurological outcomes were assessed with the modified Rankin Scale (mRS) with consideration of patient age: more than 2 points on the mRS was regarded as a poor outcome in patients under 80 years old, and more than 3 points was considered a poor outcome in those over 80 years old. The risk factors contributing to poor outcomes were evaluated. RESULTS: From 2008 to 2017, 35 patients underwent urgent STA-MCA bypass for progressing stroke. The average patient age was 70.4 years (range 49-96 years). The mean National Institutes of Health Stroke Scale (NIHSS) score was 5.1 (range 0-24 points) on admission and 7.8 before surgery. After 3 months, 25 patients showed good outcomes. The preoperative NIHSS score contributed to a poor outcome (odds ratio 1.65 (95% confidence interval 1.12-2.90)). CONCLUSIONS: Urgent STA-MCA bypass is a treatment option for patients with progressing stroke. The operation should be performed while the NIHSS score is low.
BACKGROUND: Intravenous recombinant tissue-type plasminogen activator (rt-PA) with/without endovascular treatment is sometimes not ideally effective for the treatment of acute hemodynamic stroke due to atherosclerotic major artery steno-occlusive disease, and some patients show fluctuation in or progression of symptoms despite intensive medical therapy. Urgent superficial temporal artery-middle cerebral artery (STA-MCA) bypass has been reported to be effective in patients with progressing stroke. OBJECTIVE: To investigate the efficacy of urgent STA-MCA bypass performed at a single institution for progressing stroke due to hemodynamic compromise caused by atherosclerosis. METHOD: We retrospectively reviewed clinical and operative records. Neurological outcomes were assessed with the modified Rankin Scale (mRS) with consideration of patient age: more than 2 points on the mRS was regarded as a poor outcome in patients under 80 years old, and more than 3 points was considered a poor outcome in those over 80 years old. The risk factors contributing to poor outcomes were evaluated. RESULTS: From 2008 to 2017, 35 patients underwent urgent STA-MCA bypass for progressing stroke. The average patient age was 70.4 years (range 49-96 years). The mean National Institutes of Health Stroke Scale (NIHSS) score was 5.1 (range 0-24 points) on admission and 7.8 before surgery. After 3 months, 25 patients showed good outcomes. The preoperative NIHSS score contributed to a poor outcome (odds ratio 1.65 (95% confidence interval 1.12-2.90)). CONCLUSIONS: Urgent STA-MCA bypass is a treatment option for patients with progressing stroke. The operation should be performed while the NIHSS score is low.