Reimplantation of the autoclaved autologous bone flap following decompressive craniectomy is a simple and cheep alternative to other techniques and is available to any institution that provides autoclaving sterilisation services. This method is associated with a low rate of surgical site infection, but with a significant rate of the bone flap resorption.

Extracranial-intracranial (EC-IC) bypass surgery is performed to allow flow augmentation in selected cases of occlusive cerebrovascular disease. The majority of EC-IC bypasses are described as an elective procedure in the prevention of hemodynamic ischemic stroke. There is only limited and controversial experience of superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis performed under urgent circumstances as a treatment of acute cerebral ischemia. We describe a unique case of a 75-year-old patient presenting with acute progressive hemodynamic ischemia after carotid endarterectomy (CEA), which developed contralaterally to the performed CEA in the region of chronic internal carotid artery (ICA) occlusion. Urgent performance of a standard STA-MCA bypass rapidly improved the cerebral hemodynamic and had an excellent therapeutic effect. The patient had recovered completely within 4 weeks of surgery. The role of urgent EC-IC bypass for stroke treatment is discussed.

Background: Endovascular ther apy (EVT) with stent retrievers has been shown to be superior and safe (in the anterior circulation) in comparison to intravenous thrombolysis (IVT) alone or no specifi c ther apy. We compared clinical outcome between patients undergo ing EVT admitted directly to comprehensive stroke centers (CSCs) and patients transfer red from primary stroke centers (PSCs) to a CSC. Materials and methods: Demographics, risk factors, and medical history of all consecutive EVT-treated stroke patients in col laborat ing stroke centers were col lected. Patients were divided into three groups: treatment with IVT in a PSC before transfer to a CSC for EVT; treatment with IVT directly in a CSC with subsequent EVT in the same center; no treatment with IVT before EVT. Neurological status us ing the National Institutes of Health Stroke Scale (NIHSS) on admis sion and at day 7 and self-suffi ciency us ing the modified Rankin Scale (mRS) at day 90 were as ses sed. Favorable clinical outcome was defi ned as an mRS score of 0-2. Fol low-up computed tomography or magnetic resonance imag ing was done to determine symp tomatic intracerebral hemor rhage (SICH). Results: A total of 568 patients (313 males; mean age, 66.1 ± 13.2 years) were registered from January 2006 to the end of July 2015. Patients in all three groups did not diff er in baseline characteristics except for the time to the start of EVT. The average delay of EVT start in patients transfer red from PSC to CSC was 45 min. Subgroups did not diff er signifi cantly in SICH prevalence (over all prevalence 5.5%) and favorable clinical outcome (over all 46.7%). Conclusion: The benefi t of direct transfer to a CSC merits further investigation. The present study showed that both approaches to stroke patient transport organization in the Czech Republic are comparably effi cient and safe. The authors declare they have no potential confl icts of interest concerning drugs, products, or services used in the study. Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy. The Editorial Board declares that the manuscript met the ICMJE "uniform requirements" for biomedical papers. Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do biomedicínských časopisů.