2026 Volume 54 Issue 2 Pages 87-92
Mechanical thrombectomy (MT) is the standard treatment for acute anterior circulation stroke; however, some patients fail to achieve recanalization (MT failure), resulting in poor outcomes. We retrospectively analyzed 12 patients aged ≤80 years treated with MT between July 2021 and June 2024 at our institution who did not achieve recanalization. Since January 2023, perfusion computed tomography (P-CT) has been performed immediately after MT to evaluate the penumbra, which is defined as reduced cerebral blood flow, prolonged mean transit time, and preserved cerebral blood volume. Patients with penumbrae underwent emergency superficial temporal artery–middle cerebral artery (STA–MCA) bypass (Group A, n = 6), whereas others received conservative therapy (Group B, n = 6). Neurological outcomes (National Institutes of Health Stroke Scale [NIHSS] at 7 days, mRS at 90 days), hemorrhagic complications, and mortality were compared. Group A showed better outcomes: 7-day NIHSS 9.5 vs. 13.3, 90-day mRS 1.8 vs. 4.1 (p = 0.03), no symptomatic hemorrhage, and mortality 0% vs. 66.7% (p = 0.026). All bypasses were patent on the postoperative 3D-computed tomography angiography (CTA) images. Emergency STA–MCA bypass guided by P-CT may improve function and survival in selected patients with MT failure. Rapid decision making and immediate surgery are crucial for limiting irreversible ischemic injuries.
