scholarly journals Bypass Surgery for Ischemic Stroke Caused by Intracranial Artery Stenosis or Occlusion

2018 ◽  
Vol 4 (1) ◽  
pp. 49-60 ◽  
Author(s):  
Ismatullah Soufiany ◽  
Khalil Ahmad Hijrat ◽  
Spina Soufiany ◽  
Lukui Chen
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Artery ◽  
Vegetative State ◽  
Superficial Temporal Artery ◽  
Case Series ◽  
Temporal Artery ◽  
Artery Stenosis ◽  
Intracranial Stenosis ◽  
Intracranial Artery ◽  
Intracranial Artery Stenosis

Surgical revascularization may be beneficial in patients with ischemic stroke caused by intracranial stenosis or occlusion who are ineligible for thrombolysis. Objective To evaluate the outcome of superficial temporal artery to middle cerebral artery (STA-MCA) bypass in ischemic stroke caused by intracranial artery stenosis or occlusion. Methods We retrospectively studied successive case series of 19 patients who underwent surgical treatment between 2013–2017 of STA-MCA bypass. Surgical procedure was performed for the patients with acute ischemic stroke who were ineligible for thrombolysis. Results Of the 19 patients enrolled, symptom aggravation occurred during medical treatment, the patients were ineligible for thrombolysis despite being within 8 hours of symptom onset. Bypass significantly improved National Institutes of Health Stroke Scale scores, mean patient age was 78.05 years (range, 39–78 y). However, male 11 (57.95%) out of nineteen patients were presented with left-sided-lesions while female 8 (42%) had right-sided lesions with significant infarction growth by diffusion weighted imaging achieved, after surgical maneuver. No major complications occurred intraoperatively, in contrast to 2 (10.5%) minor manifestation were suffering minor complications probably they included the remote infarction (posterior cerebral artery territory). Pooled analysis with our patients showed a significant neurological improvement and a good outcome in 13 (68.4%) patients without hemorrhage or any other complication, 6 (31.6%) patients with unfavorable outcome (severe disability 2; vegetative state 4, non of them are died 0;). Conclusion STA-MCA bypass may be beneficial to patients with acute stroke or stenosis in progress who are ineligible for medical therapy. Furthermore, it appears safe when the infarction is small. These findings indicate that STA-MCA bypass could be considered as a treatment option in selected patients with ischemic stroke caused by intracranial stenosis or occlusion.

Abstract T P101: Low Serum Eicosapentaenoic Acid- Arachidonic Acid Ratio is Associated With Intracranial Stenosis in Patients With Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yuko Abe ◽  
Ryoichi Otsubo ◽  
Sho Murase ◽  
Kenichiro Nakazawa ◽  
Kazuo Kitagawa
Keyword(s):  
Risk Factors ◽  
Arachidonic Acid ◽  
Ischemic Stroke ◽  
Eicosapentaenoic Acid ◽  
Acute Ischemic Stroke ◽  
Artery Stenosis ◽  
Intracranial Artery ◽  
Stroke Subtype ◽  
Fa Composition ◽  
Intracranial Artery Stenosis

Purpose: A low ratio of serum eicosapentaenoic acid to arachidonic acid (EPA/AA) has been associated with atherosclerotic disease. Few studies investigate the association of serum fatty acid (FA) composition with the acute ischemic stroke so far. Our aim of this study is to evaluate the relationships between FA composition and stroke subtypes, extra-/intracranial atherosclerotic stenoses, and other cerebrovascular indicators Methods: This study included 154 consecutive patients who were admitted to our hospital because of acute ischemic stroke between April 2011 and March 2012. We examined the FA composition and classical vascular risk factors. We conducted brain MRI/MRA, carotid ultrasonogram, transthoracic echocardiogram, 24hr Holter electrocardiogram, ankle brachial index (ABI) and pulse wave velocity (PWV) in order to evaluate the severity of atherosclerotic change, stroke subtype, and cardiovascular status. Results: The mean value of EPA/AA was 0.33±0.22 in all patients with acute cerebral infarction. The 154 patients in this study (mean age 71 years) were categorized as follows; large artery atherosclerosis (LA; n=57), small artery occlusion (SA; n=48), cardiogenic embolism (CE; n=18), and others (n=31). We found intracranial artery stenosis greater than 50% in 70 patients (45%). The intracranial artery stenosis was associated with low EPA/AA ratio (P=0.013) and low EPA concentration (P=0.013). This association remained significant (P<0.05) after controlling for classical atherosclerotic risk factors. We could not find a significant correlation between FA composition and stroke subtype. However, there was a tendency for the EPA/AA ratio of LA patients to be the lowest among all subtype groups. The EPA/AA ratio was not associated with ABI, PWV, prevalence of arrhythmia, or cardiac function. Conclusions: A low EPA/AA ratio was significantly associated with intracranial stenosis in patients with acute ischemic stroke. This study shows the EPA/AA ratio might be an important marker to reflect the cerebral artery stenosis.

Plasma Levels of Apolipoprotein E and Risk of Intracranial Artery Stenosis in Acute Ischemic Stroke Patients

2013 ◽  
Vol 62 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Yong-Jae Kim ◽  
Seung-Min Lee ◽  
Hyun-Ji Cho ◽  
Hyun Ju Do ◽  
Chang Hyung Hong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Apolipoprotein E ◽  
Acute Ischemic Stroke ◽  
Plasma Levels ◽  
Artery Stenosis ◽  
Intracranial Artery ◽  
Stroke Patients ◽  
Intracranial Artery Stenosis

Superficial Temporal Artery to Middle Cerebral Artery Bypass in Acute Ischemic Stroke and Stroke in Progress

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. 723-730 ◽  
Author(s):  
Gyojun Hwang ◽  
Chang Wan Oh ◽  
Jae Seung Bang ◽  
Cheol Kyu Jung ◽  
O-Ki Kwon ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Mean Transit Time ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Pooled Analysis

Abstract BACKGROUND: Surgical reperfusion may be beneficial in patients with acute ischemic stroke who are ineligible for thrombolysis. OBJECTIVE: To evaluate the outcome of superficial temporal artery to middle cerebral artery (STA-MCA) bypass in acute stroke and stroke in progress. METHODS: The clinical and radiological data of 9 patients treated by STA-MCA bypass requiring urgent reperfusion but ineligible for intra-arterial thrombolysis (IAT) were reviewed. Pooled analysis was performed of published literature concerning STA-MCA bypass in acute stroke (21 cases in 2 articles). RESULTS: Of the 9 patients enrolled, symptom aggravation occurred during medical treatment in 4 patients and after IAT in 2. Three patients were ineligible for IAT despite being within 8 hours of symptom onset. Bypass significantly improved National Institutes of Health Stroke Scale scores (preoperatively, 12.4 ± 4.88; 3 days postoperatively, 8.6 ± 6.39, P = .046; discharge, 5.4 ± 5.15, P = .008; 3 mo postoperatively 3.7 ± 4.82, P = .008) without significant infarction growth by diffusion weighted imaging (preoperatively, 15.0 ± 8.87 mL; 7 days postoperatively, 15.2 ± 8.28 mL; P = .110). Abnormal perfusion regions (mean transit time &gt;145% of contralateral side value) were reduced in all cases (2.63 ± 0.93 mL). Good outcomes (modified Rankin scale ≤2) were achieved by 6 patients. Pooled analysis with our patients showed a significant neurological improvement (P &lt; .001) and a good outcome in 25 (83.3%) patients without hemorrhage or complication. CONCLUSION: STA-MCA bypass may be beneficial to patients with acute stroke or stroke in progress who are ineligible for IAT. Furthermore, it appears safe when the infarction is small. These findings indicate that STA-MCA bypass could be considered as a treatment option in selected patients with acute stroke or stroke in progress.

scholarly journals Challenge of Identifying the Cause of Intracranial Artery Stenosis in Patients With Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (3) ◽  
Author(s):  
Sylvain Lanthier ◽  
Céline Odier ◽  
Sophia Sundararajan ◽  
Daniel Strbian
Keyword(s):  
Ischemic Stroke ◽  
Artery Stenosis ◽  
Intracranial Artery ◽  
Intracranial Artery Stenosis

scholarly journals Neurology (Stroke)

2015 ◽  
Vol 42 (S1) ◽  
pp. S36-S36
Author(s):  
H Liu ◽  
X Wu ◽  
Y Xing ◽  
K Liu ◽  
H Zhang
Keyword(s):  
Risk Factor ◽  
Cerebral Artery ◽  
Transcranial Doppler ◽  
Duplex Sonography ◽  
Artery Stenosis ◽  
Age Group ◽  
Intracranial Artery ◽  
Chinese Cohort ◽  
Intracranial Artery Stenosis ◽  
Intracranial Arteries

Background: Cerebral artery stenosis is an important risk factor for ischemic strokes. This study aims to explore intracranial and extracranial artery stenosis in a large northeast Chinese cohort. Methods: We recruited 14793 outpatients and hospitalized patients to identify cerebral artery stenosis. Artery stenosis screening was done with transcranial Doppler (TCD) for intracranial arteries and carotid duplex sonography for extracranial arteries. Results: More intracranial than extracranial artery stenoses were identified (4255 versus 2809, i.e. 28.8% versus 19.0%, P<0.05). Similarly, mere intracranial stenosis was significantly more common than extracranial artery stenosis in this population (2632 versus 1186, i.e. 17.8% versus 8%, P<0.05). Among all identified intracranial arteries stenoses, the proportion of middle cerebral artery (MCA) stenosis was the highest. More intracranial than extracranial artery stenoses was seen within each age group, and rates of both increased with age. Intracranial and extracranial artery stenosis was more frequently identified in males than females. Conclusions: Incidence of cerebral artery stenosis in the population increases with age. Intracranial artery stenosis is more common than extracranial artery stenosis and the MCA stenosis accounted for the highest proportion, within each age group. More males suffer from intracranial or extracranial artery stenosis than females.

scholarly journals Ischemic Stroke Due to Dissection of the Middle Cerebral Artery Treated by Superficial Temporal Artery-Middle Cerebral Artery Anastomosis

2011 ◽  
Vol 51 (7) ◽  
pp. 503-506 ◽  
Author(s):  
Koichi TORIHASHI ◽  
Masaki CHIN ◽  
Nobutake SADAMASA ◽  
Kazumichi YOSHIDA ◽  
Osamu NARUMI ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery

Superficial Temporal Artery to Middle Cerebral Artery Cranial Bypass for Nonmoyamoya Steno-Occlusive Disease in Patients Who Failed Optimal Medical Treatment: A Case Series

2021 ◽  
Author(s):  
Joseph Haynes ◽  
Annick Kronenburg ◽  
Eytan Raz ◽  
Sara Rostanski ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Case Series ◽  
Temporal Artery ◽  
Occlusive Disease ◽  
Small Series ◽  
Recurrent Strokes ◽  
Distal Perfusion

Abstract BACKGROUND In the post-Carotid Occlusion Surgery Study (COSS) era, multiple reviews suggested subset groups of patients as potential candidates for superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Among them are patients with recurrent strokes despite optimal medical therapy. There is a paucity of data on the outcome of bypass in these specific patients. OBJECTIVE To examine the safety and efficacy of direct STA-MCA bypass in patients with nonmoyamoya, symptomatic steno-occlusive disease with impaired distal perfusion, who failed optimal medical management or endovascular treatment. METHODS A retrospective review was performed to identify patients with cerebrovascular steno-occlusive disease who underwent bypass after symptomatic recurrent or rapidly progressive strokes, despite optimal conservative or endovascular treatment. RESULTS A total of 8 patients (mean age 60 ± 6 yr) underwent direct or combined direct/indirect STA-MCA bypass between 2016 and 2019. All anastomoses were patent. One bypass carried slow flow. There were no procedure-related permanent deficits. One patient developed seizures which were controlled by medications. A total of 7 out of 8 patients were stable or improved clinically at last follow-up (mean 27.3 ± 13.8 mo) without recurrent strokes. One patient did not recover from their presenting stroke, experienced severe bilateral strokes 4 mo postoperatively, and subsequently expired. Modified Rankin Scale (mRS) improved in 6 patients (75%), remained stable in 1 patient (12.5%), and deteriorated in 1 (12.5%). Good long-term functional outcome was achieved in 5 patients (63%, mRS ≤ 2). CONCLUSION Patients with symptomatic, hypoperfused steno-occlusive disease who fail optimal medical or endovascular treatment may benefit from cerebral revascularization. Direct or combined STA-MCA bypass was safe and provided favorable outcomes in this small series.

scholarly journals Prevalence of Intracranial Artery Stenosis in Patients with Acute Ischemic Stroke in a Tertiary Care Hospital of China

2020 ◽  
Vol 58 (229) ◽  
Author(s):  
Sandip Kumar Jaiswal ◽  
Yan Fuling ◽  
Min Li
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Posterior Circulation ◽  
Artery Stenosis ◽  
Care Hospital ◽  
Intracranial Artery ◽  
Anterior Circulation ◽  
Intracranial Artery Stenosis

Introduction: Intracranial artery stenosis is the most common cause of acute ischemic stroke, especially among people in Asia. About its epidemiology, however little is understood. The goal of our research is to establish the prevalence of intracranial artery stenosis in patients with acute ischemic stroke in a tertiary care hospital. Methods: A descriptive cross-sectional study was done in 1006 acute ischemic stroke patients at Affiliated Zhongda Hospital, School of Medicine, Southeast University China from May 2018 to May 2019. Ethical approval was taken from the Ethical review committee of the institution. A convenient sampling method was done. Intracranial artery stenosis was diagnosed when evidence of acute ischemic stroke was found in the territory of approximately 2 50% stenosis identified by Transcranial Doppler ultrasound and confirmed by magnetic resonance angiography or computed tomography. Statistical analysis was done using the Statistical Package for the Social Sciences version 20. Results: The prevalence of intracranial artery stenosis was found in 331 (32.90%) patients at 95% Confidence interval (0.24-0.42%). Among 331 cases the anterior circulation artery stenosis was present on 201 (19.98%) patients, followed by posterior circulation artery stenosis on 80 (7.95%) patients, then anterior plus posterior circulation artery stenosis on 50 (4.97%) patients. Conclusions: Intracranial artery stenosis is one of the most causes of acute ischemic stroke in China. The proportion of anterior circulation artery stenosis was higher than that in the posterior circulation.

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