Yun Ho Noh1, Jae Woo Chung2, Jung Ho Ko2, Hae Won Koo3, Ji Young Lee1, Seok Mann Yoon1, In-Hag Song4, Man Ryul Lee5, Jae Sang Oh6. 1. Department of Neurosurgery, Soonchunhyang University, College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea. 2. Department of Neurosurgery, Dankook University, College of Medicine, Dankook University Hospital, Cheonan, Republic of Korea. 3. Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Republic of Korea. 4. Department of Thoracic and Caridovacular Surgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea. 5. Soonchunhyang Institute of Medi-bio Science, Soon Chun Hyang University, Cheonan, Republic of Korea. 6. Department of Neurosurgery, Soonchunhyang University, College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea. Electronic address: metatron1324@hotmail.com.
Abstract
BACKGROUND: Endovascular treatment (EVT) is less effective for intracranial atherosclerosis-induced emergent large vessel occlusion. Extracranial-intracranial (EC-IC) bypass surgery is a possible treatment option to augment cerebral blood flow in the perfusion defect area. We compared the efficacy and safety of EC-IC bypass surgery with those of EVT and maximal medical treatment for acute ischemic stroke. METHODS: The data from 39 patients, for whom vessel revascularization had failed despite mechanical thrombectomy, were retrospectively analyzed. Of the 39 patients, 22 had undergone percutaneous transluminal angioplasty or intracranial stenting (PTA/S), 10 had undergone emergency EC-IC bypass surgery within 24 hours of symptom onset, and 7 had received maximal medical treatment (MMT) only. The patency, perfusion status, and postoperative infarct volume were evaluated. The clinical outcomes were assessed at 6 months postoperatively using the modified Rankin scale. RESULTS: The mean reperfusion time was significantly longer for the EC-IC bypass group (14.9 hours) compared with that in the PTA/S group (4.1 hours) and MMT group (7.5 hours; P < 0.05). The postoperative infarct volume on diffusion-weighted magnetic resonance imaging was significantly lower in the emergency EC-IC bypass group (11.3 cm3) than in the MMT group (68.0 cm3) but was not significantly different from that of the PTA/S group (14.0 cm3; P < 0.05). The proportion of patients with a modified Rankin scale score of 0-2 at 6 months after surgery was significantly higher in the EC-IC bypass group (80%) than in the PTA/S (59%) and MMT (14%) groups (P < 0.05). CONCLUSIONS: Emergency EC-IC bypass surgery is an effective and safe treatment option for intracranial atherosclerosis-induced acute ischemic stroke for which EVT is inadequate.
BACKGROUND: Endovascular treatment (EVT) is less effective for intracranial atherosclerosis-induced emergent large vessel occlusion. Extracranial-intracranial (EC-IC) bypass surgery is a possible treatment option to augment cerebral blood flow in the perfusion defect area. We compared the efficacy and safety of EC-IC bypass surgery with those of EVT and maximal medical treatment for acute ischemic stroke. METHODS: The data from 39 patients, for whom vessel revascularization had failed despite mechanical thrombectomy, were retrospectively analyzed. Of the 39 patients, 22 had undergone percutaneous transluminal angioplasty or intracranial stenting (PTA/S), 10 had undergone emergency EC-IC bypass surgery within 24 hours of symptom onset, and 7 had received maximal medical treatment (MMT) only. The patency, perfusion status, and postoperative infarct volume were evaluated. The clinical outcomes were assessed at 6 months postoperatively using the modified Rankin scale. RESULTS: The mean reperfusion time was significantly longer for the EC-IC bypass group (14.9 hours) compared with that in the PTA/S group (4.1 hours) and MMT group (7.5 hours; P < 0.05). The postoperative infarct volume on diffusion-weighted magnetic resonance imaging was significantly lower in the emergency EC-IC bypass group (11.3 cm3) than in the MMT group (68.0 cm3) but was not significantly different from that of the PTA/S group (14.0 cm3; P < 0.05). The proportion of patients with a modified Rankin scale score of 0-2 at 6 months after surgery was significantly higher in the EC-IC bypass group (80%) than in the PTA/S (59%) and MMT (14%) groups (P < 0.05). CONCLUSIONS: Emergency EC-IC bypass surgery is an effective and safe treatment option for intracranial atherosclerosis-induced acute ischemic stroke for which EVT is inadequate.
Authors: Jan C Purrucker; Peter A Ringleb; Fatih Seker; Arne Potreck; Simon Nagel; Silvia Schönenberger; Anne Berberich; Ulf Neuberger; Markus Möhlenbruch; Charlotte Weyland Journal: Ther Adv Neurol Disord Date: 2022-05-25 Impact factor: 6.430
Authors: David Černík; Robert Bartoš; Jarmila Neradová; Nicol Frenštátská; Filip Cihlář; Štěpánka Brušáková; Martin Sameš Journal: Front Neurol Date: 2022-09-16 Impact factor: 4.086