Reappraisal of Microsurgical Revascularization for Anterior Circulation Ischemia in Patients with Progressive Stroke

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• 作者：Taku Sugiyama¹ ; ^{taku-s@yk9.so-net.ne.jp" class="auth_mail" title="E-mail the corresponding author} ; Ken Kazumata² ; Katsuyuki Asaoka¹ ; Toshiya Osanai² ; Daisuke Shimbo¹ ; Kazuki Uchida¹ ; Yuka Yokoyama¹ ; Naoki Nakayama² ; Kouji Itamoto¹ ; Kiyohiro Houkin²
• 关键词：Acute ischemic stroke ; EC-IC bypass ; Embolectomy ; Progressive stroke ; STA-MCA bypass
• 刊名：World Neurosurgery
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：84
• 期：6
• 页码：1579-1588
• 全文大小：5440 K

文摘

Intravenous thrombolysis using tissue plasminogen activator and endovascular treatment for acute ischemic stroke is becoming an established standard therapy. However, there is no consensus in the treatment of patients who are suffering from progressive neurologic symptoms in the later stages. The purpose of this study was to evaluate the safety and efficacy of microsurgical revascularization in such patients with progressive stroke.

Methods

We retrospectively reviewed the clinical and radiological records of 14 consecutive patients with progressive stroke who underwent emergency open surgery for anterior circulation occlusion within 7 days after onset. Surgical candidates were carefully selected on the basis of symptom severity, diffusion-weighted imaging, and perfusion study. Superficial temporal artery to middle cerebral artery bypass was applied for atherosclerotic occlusion, and microsurgical embolectomy was applied for embolic occlusion.

Results

Superficial temporal artery to middle cerebral artery bypass was performed in 12 patients, microsurgical embolectomy in 1, and the combination of these modalities in 1. As a result, complete revascularization was achieved in all patients. The National Institutes of Health Stroke Scale scores significantly improved after surgery (at third postoperative day, P < 0.05; at 14th postoperative day, P < 0.01). A favorable outcome (modified Rankin Scale 0–2) was achieved in 12 of the 14 (85.7%) patients. Minor intracerebral hemorrhage occurred in 1 patient and hyperperfusion syndrome occurred in 1 patients; however, the patients subsequently recovered without additional treatment.

Conclusions

Microsurgical revascularization is a feasible treatment option for patients with progressive stroke due to anterior circulation major vessel occlusion.