2019 Volume 24 Issue 1 Pages 39-44
Several randomized controlled trials have established that an acute thrombectomy is recommended for acute cerebral infarction within 8 hr of onset. A standard treatment has not been established for resistant and/or ineffective cases after thrombolytic therapy. We herein describe the surgical outcomes of non‒cardiac occlusive patients who underwent an emergent extracranial‒to‒intracranial bypass within 72 hr of onset, and we discuss the advantages of this surgery and its pitfalls. We retrospectively analyzed the medical charts of 14 consecutive non‒cardiac cerebrovascular occlusive stroke patients who underwent emergent bypass surgery at the acute stage at 8‒72 hr post‒stroke onset, and we examined clinical and treatment outcomes. The patients were nine males and six females, mean age 70 years (range 43‒82 years). We determined the surgical indications in consideration of the observed progressive cerebral infarction with National Institutes of Health Stroke Scale (NIHSS) scores ≥ 4 points, occlusion of the main artery (IC, M1), small cortical infarction (≤ 1/3), and perfusion‒diffusion mismatch. The average NIHSS on admission was 9.5. Seven infarctions were in the middle cerebral artery (MCA: M1) and there were seven internal carotid artery occlusion cases. The average time from the stroke onset to surgery was 36 hr (12‒72 hr). The surgical outcome was good recovery in two patients, moderate disability in six, severe disability in five, and one death. The favorable outcome rate was 57.1%; the poor outcome rate was 42.9%. No patient suffered any complication related to surgical intervention, including hemorrhagic complications. Our analyses indicate that in non‒cardiac acute cerebrovascular stroke patients, emergent superficial temporal artery (STA)‒MCA bypass surgery (which can improve clinical outcomes and reduce the risk of morbidity under strict surgical indications) can be an option for acute‒stage revascularization for cases in which thrombolytic therapy was ineffective.
