Ischemic stroke following STA–MCA double bypass

Abstract

Objectives The surgical technique of STA–MCA double bypass is used to improve blood flow supplied by the distal middle cerebral artery (MCA) to the cerebral territory. This retrospective study from a single center aimed to compare the outcomes following STA–MCA double bypass in 12 patients with recurrent ischemic stroke. Materials and methods We retrospectively analyzed the data from patients with internal carotid artery occlusion (ICAO) who had undergone STA–MCA double bypass in our center from January 2016 to December 2020. The surgical indications, evaluation of circle of Willis (CoW), changes in cerebral hemodynamic, surgical results, and follow-up results were analyzed. Results Post-operative perfusion-weighted imaging showed hemodynamic improvement in all 12 patients. Ten patients (83.33%) showed clinical improvement, and 2 patients (16.67%) had stable disease. No intracranial infections or acute ischemic events occurred. The post-operative National Institutes of Health Stroke Scale score and modified Barther scores were significantly improved after 180 days of follow-up. Twenty three (96%) anastomoses maintain patency of their bypass vessels, and none had recurrent cerebral infarction during a minimum of 36 months follow-up. Conclusion In this small study, in patients with recurrent ischemic stroke without other types of treatment, STA–MCA double bypass surgery was more effective in the subgroup of patients with ICAO and poor blood supply to the CoW and an area of cerebral hypoperfusion that exceeded the area supplied by the MCA.

Risk Factors of Recurrent Stroke in Young and Middle-Aged Stroke Patients after Interventional Therapy

“…(1) Patients were diagnosed with stroke by brain CT or MRI, meeting the diagnostic criteria formulated on the Fourth National Academic Conference on cerebrovascular diseases [ 9 ], (2) the color ultrasound examination of neck vessels showed the presence of vulnerable plaques in the internal carotid artery (ICA) and common carotid artery of patients, (3) severe atherosclerotic intracranial artery stenosis was detected, and the stenosis artery was the offending vessel of the lesions after cerebral angiography or CTA examination in patients, (4) patients received interventional therapy, with complete clinical data, (5) patients were aged 18–59 years, and (6) patients could communicate normally and cooperate with follow-up…”

Revisiting flow augmentation bypass for cerebrovascular atherosclerotic vaso-occlusive disease: Single-surgeon series and review of the literature

“…Our study provided evidence of improved functional outcomes following bypass in one of the largest post-COSS series of patients with recurrent ischemic disease. This benefit has been corroborated by other centers [7,[19][20][21][22]. In addition to work by Haynes and colleagues, Zhao et al showed improved imaging and cognitive outcomes in 12 patients with recurrent strokes due to intracranial large artery occlusion, with only one perioperative TIA [7].…”

“…This benefit has been corroborated by other centers [7,[19][20][21][22]. In addition to work by Haynes and colleagues, Zhao et al showed improved imaging and cognitive outcomes in 12 patients with recurrent strokes due to intracranial large artery occlusion, with only one perioperative TIA [7]. White et al demonstrated excellent graft patency of 94% with only 3 perioperative strokes in an unselected [20].…”

“…We reviewed the literature for post-COSS series of EC-IC bypass for steno-occlusive disease and compared them to our own as shown in Table 6 [7,8,[19][20][21][22][23][24]. Seven of 8 studies (87.5%) were retrospective in nature.…”

“…Multiple randomized-controlled trials have generated high quality evidence for the use of antiplatelet therapy, anticoagulation, and thrombolysis for treatment and prevention of stroke [1]. Unfortunately, certain stroke etiologies, including severe intracranial large artery occlusion and patients with chronic retinal ischemia or limb-shaking transient ischemic attacks (TIAs), have a 15-20% risk of recurrence despite optimal nonsurgical therapy [4][5][6][7][8][9]. These recurrent ischemic events reduce patient quality of life and carry significant morbidity and mortality [1,4].…”