Revision Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery for Recurrent Acute Ischemic Stroke Due to Delayed Occlusion of the Bypass Graft

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 >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 < .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.

Download Full-text

Delayed reopening of a superficial temporal artery to middle cerebral artery bypass graft occluded by a white thrombus during surgery

Surgical Neurology International ◽

10.25259/sni_235_2020 ◽

2020 ◽

Vol 11 ◽

pp. 220

Author(s):

Satoshi Takahashi ◽

Kazunari Yoshida

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Bypass Surgery ◽

Positive Impact ◽

Artery Bypass ◽

Bypass Graft ◽

Superficial Temporal Artery ◽

Chronic Phase ◽

Temporal Artery ◽

Recipient Vessel

Background: To the authors’ knowledge, reopening of a superficial temporal artery to middle cerebral artery (STA-MCA) bypass graft occluded by a white thrombus during the procedure and was observed several months after the surgery is relatively rare. Case Description: The authors encountered a case of moyamoya disease in an Asian female in her third decade of life, in whom a bypass recipient vessel was occluded by a white thrombus during surgery and remained occluded on magnetic resonance angiography (MRA) performed up to 6 weeks after the procedure. However, recanalization was confirmed by MRA performed 4 months after surgery. MRA performed 10 and 19 months after surgery revealed that the bypass vessel had grown thicker, and the ischemic symptoms experienced by the patient also improved. Conclusion: Whether this lesion is explained by reopening or angiogenesis, its pathophysiology remains controversial. The uninterrupted connection of occluded bypass vessel in STA-MCA bypass surgery in conjunction with surgical strategy of single bypass using only parietal branch of STA as donor and preserving blood flow of frontal branch to scalp may have made a positive impact on promoting the development of extracranial-intracranial bypass anastomosis in the chronic phase and should be considered.

Download Full-text

Early superficial temporal artery to middle cerebral artery bypass in acute ischemic stroke

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2012.11.022 ◽

2013 ◽

Vol 115 (8) ◽

pp. 1238-1244 ◽

Cited By ~ 13

Author(s):

Sang-Bok Lee ◽

Pil-Woo Huh ◽

Dal-Soo Kim ◽

Do-Sung Yoo ◽

Tae-Gyu Lee ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Cerebral Artery ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Temporal Artery

Download Full-text

Evaluation for Perfusion Areas of Bypass Flow by Intraoperative Near-infrared Indocyanine Green Videoangiography in Superficial Temporal Artery-middle Cerebral Artery Bypass Surgery

Surgery for Cerebral Stroke ◽

10.2335/scs.37.233 ◽

2009 ◽

Vol 37 (4) ◽

pp. 233-239 ◽

Cited By ~ 2

Author(s):

Yuji KODAMA ◽

Hideyuki OHNISHI ◽

Katsushi TAOMOTO ◽

Yoshihiro KUGA ◽

Kazuya NAKASHIMA ◽

...

Keyword(s):

Indocyanine Green ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Bypass Surgery ◽

Near Infrared ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Bypass Flow ◽

Indocyanine Green Videoangiography

Download Full-text

Efficacy and Safety of Timely Urgent Superficial Temporal Artery-to-Middle Cerebral Artery Bypass Surgery in Patients with Acute Ischemic Stroke: A Single-Institutional Prospective Study and a Pooled Analysis

Cerebrovascular Diseases ◽

10.1159/000512106 ◽

2021 ◽

pp. 1-12

Author(s):

Jang Hun Kim ◽

Wonki Yoon ◽

Chi Kyung Kim ◽

Haewon Roh ◽

Hee Jin Bae ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Cerebral Artery ◽

Bypass Surgery ◽

Superficial Temporal Artery ◽

Pooled Analysis ◽

Published Data ◽

Efficacy And Safety ◽

Nihss Score

Background: Clinical outcome in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) is not satisfactory if reperfusion treatment fails or is not tried. Aims: We aimed to assess the efficacy and safety of urgent superficial temporal-to-middle cerebral artery (STA-MCA) bypass surgery in selected patients. Methods: Patients who were diagnosed with LVO-induced AIS in the anterior circulation but had a failed intra-arterial thrombectomy (IAT) or were not tried due to IAT contraindications were prospectively enrolled. Timely urgent STA-MCA bypass surgery was performed if they showed perfusion-diffusion mismatch or symptom-diffusion mismatch in the acute phase of disease. Clinical and radiological data of these patients were assessed to demonstrate the safety and efficacy of urgent bypass procedures. A pooled analysis of published data on urgent bypass surgery in acute stroke patients was conducted and analyzed. Results: In 18 patients who underwent timely bypass, the National Institutes of Health Stroke Scale (NIHSS) score improved from 12.11 ± 4.84 to 9.89 ± 6.52, 1 week after surgery. Three-month and long-term (9.72 ± 5.00 months) favorable outcomes (modified Rankin Scale [mRS] scores 0–2) were achieved in 50 and 75% of the patients, respectively. The pooled analysis (117 patients from 10 articles, including ours) identified favorable mRS scores in 71.79% patients at 3 months. A significant NIHSS score improvement from 11.51 ± 4.89 to 7.59 ± 5.50 was observed after surgery with significance. Major complications occurred in 3 patients (2.6%, 3/117) without mortality. Conclusions: Urgent STA-MCA bypass surgery can be regarded as a safe optional treatment to prevent cerebral infarct expansion and to improve clinical and radiological outcomes in highly selected patients.

Download Full-text