Bypass Surgery For Ischemic Stroke Caused By Intracranial Artery Stenosis Or Occlusion

Background:A clinical results of an extra-intracranial arterial bypass（EC-IC）procedure for cerebral ischemic stroke caused by intracranial stenosis or occlusion assessed in 19^th patients.The suggestive bypass techniques procedure has a protective effect against further clinically significant cerebrovascular accidents in properly selected patients.Correlation with angiography and regional cerebral blood flow（rCBF）studies are discussed.It is felt that rCBF measurements offer the best diagnostic test to determine which patients are suitable for surgery by revealing if an ischemic or relative ischemic stroke caused by intracranial stenosis or occlusion is present.The surgical procedure is contraindicated in acute cerebral ischemia and when the rCBF study reveals general reduction of cerebral blood flow as opposed to a localized ischemic focus.surgical re-vascularization may be beneficial in patients with ischemic stroke caused by intracranial stenosis or occlusion who are ineligible for thrombolysis.Methods:Retrospectively successive case series of 19 patients who underwent surgical treatment between 2013-2017 of STA-MCA bypass,Surgical procedure preformed for the patients with acute ischemic stroke who were ineligible for thrombolysis.To evaluate the outcome of superficial temporal artery to middle cerebral artery（STA-MCA）bypass in acute stroke and stroke in progress,with cortical selective-targeted EC-IC bypasses is presented.All patients were operated on by the senior Doctor Prof.Chen Lu Kui in Zhong Da Hospital Medical Center,affiliated with Southeast University,Nanjing China.over period of 48-month.Results:Clinical and demographic data of 19 patients were summarized in Table 4.Patients’age ranged from 39 to 78 yrs（average 61.26 yrs）.11（58%）out of nineteen patients were presented with left-sided lesions while 8（42%）had right-sided lesions.On physical examination,4（21.2%）patients had conscious disturbance,16（84.2%）motor weakness,5（26.3%）aphasic,3（15.8）cognitive disturbance and 3（15.8%）Crescendo TIA.Four patients（21.1%）were presented with progressive intracranial ICA stenosis,seven（36.8%）patients were diagnosed with proximal M1 occlusion as compared to 5（26.3%）patients in distal M1,and three（15.8%）patients were hospitalized due to M2 stenosis.According to the severity of neurological deficits,single bypass was performed in 17（89.5%）patients,while double bypass was selected for 2（10.5%）patients.A significant improved neurological symptoms and a good functional outcome were achieved in 12（63.2%）patients,unchanged in 6（31.6%）patients,worsened in 1（5.3%）patient.New infarction was prevented after16（84.2%）surgeries.Perioperative complications were presented in Table 4.No major complication was reported in any case,1（5.3%）patient was suffering minor complications one week after surgery,that is,remote infarction（frontal lobe）.Thirteen（68.4%）patients had favorable outcome（good recovery,moderate disability）at discharge,while 6（31.6%）were unfavorable（severe disability）.Conclusion:Because Cerebral bypass is the standard revascularization method used in acute ischemic stroke,caused by intracranial artery stenosis or occlusions,should be considered as a first method in every case requiring urgent revascularization.However,our series of 19 patients and our pooled analysis demonstrate that STA-MCA bypass may be beneficial to patients with acute ischemic stroke or occlusions in progress in whom medical therapy failed.Additionally,the low flow provided by STA-MCA bypass appears safe in cases with a small infarction.Accordingly,our findings indicate that STAMCA bypass could be considered a treatment option in selected patients with acute ischemic stroke or stenosis in progress.