Emergency extracranial-intracranial bypass surgery for acute ischemic stroke

Abstract

In the authors' experience, emergency EC-IC bypass in patients with acute ischemic injury was both safe and effective. This population was characterized by relatively young patients with severely limited collateral circulation. In this series of 13 carefully selected patients, bypass was successful in arresting progression of stroke, and in some cases resulted in rapid neurological improvement.

Emergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke

“…This result was consistent with recent investigations [5,7]. However, previous study [11] demonstrated that 4 (11%) of 35 patients had hemorrhagic infarction after urgent bypass surgery.…”

“…By contrast, surgical revascularization may be effective to some patients who suffered from medication-resistance hemodynamic stroke in acute stage [3][4][5][6][7]10]. However, safety and efficacy of surgical revascularization for ischemic stroke in acute stage is still controversial.…”

“…Therefore, low flow bypass surgery comparing with embolectomy and carotid endarterectomy may be a relative low risk of hemorrhagic transformation. According to recent publications [5,7] of urgent EC-IC bypass, no reperfusion-related complications were observed. In the present study, perforator infarction occurred after bypass surgery in the presented Case 2.…”

Role of and Indications for Bypass Surgery After Carotid Occlusion Surgery Study (COSS)?

“…49 Several different reperfusion methods are available: intravenous thrombolysis, intra-arterial thrombolysis or mechanical thrombectomy, carotid endarterectomy, angioplasty/stenting, surgical embolectomy, and EC-IC bypass. 50 Level I evidence now exists for endovascular interventions [51][52][53] in an emergency setting. Only few descriptive case series exist describing the role of urgent EC-IC bypass in treating patients with acute and progressive ischemic symptoms despite optimal medical therapy because of acute atherosclerotic stenoocclusive event; these report good results in term of patients' outcome.…”

“…Only few descriptive case series exist describing the role of urgent EC-IC bypass in treating patients with acute and progressive ischemic symptoms despite optimal medical therapy because of acute atherosclerotic stenoocclusive event; these report good results in term of patients' outcome. 50,54,55 These case series all have a retrospective design and are therefore vulnerable to selection bias. Furthermore, they have been published before the recent RCTs reinforcing the role of endovascular therapy for stroke.…”