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Emergency Superficial Temporal Artery-Middle Cerebral Artery Bypass for Atherosclerotic Ischemic Stroke Toshiichi WATANABE 1 , Toshiaki OSATO 1 , Kaori HONJO 1 , Kouichiro SHINDO 2 , Kenji KAMIYAMA 1 , Hirohiko NAKAMURA 1 1Department of Neurosurgery, Nakamura Memorial Hospital 2Department of Neurosurgery, Nakamura Memorial South Hospital Keyword: STA-MCAバイパス術 , 再灌流治療 , 急性期脳梗塞 , 急性期バイパス術 , アテローム血栓性閉塞 , STA-MCA bypass , revascularization , acute ischemic stroke , emergency bypass , atherosclerotic occlusion pp.797-805
Published Date 2022/7/10
DOI https://doi.org/10.11477/mf.1436204623
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 Endovascular recanalization is the primary strategy for the treatment of acute embolic stroke. However, atherosclerotic occlusions are often challenging to recanalize, and only medical therapy can be performed. In these cases, even the best medical treatment may not be effective, and the cerebral infarction progressively worsens. We believe that an emergency superficial temporal artery-middle cerebral artery(STA-MCA)bypass could be effective in these situations, after careful case selection. We use the following eligibility criteria: (1)atherosclerotic infarction; (2)cerebral ischemia with blood flow < 70% of the contralateral side; (3)progressively worsening symptoms or widening of the subcortical infarction despite medical treatment; and(4)surgery availability < 72 h from symptom onset.

 Among the 35 patients who underwent urgent STA-MCA bypass from 2014 to 2020, 27(77.1%)gained gait independence, and the National Institutes of Health Stroke Scale(NIHSS)scores improved from a preoperative median of 8 to 3 at discharge. The modified Rankin score(mRS)improved from a preoperative median of 5 to 2 at discharge.

 No intracerebral hemorrhages occurred due to hyper-perfusion syndrome. When we match it with other reports, this emergency surgery allows 76-90% of patients with progressive stroke to achieve gait independency.


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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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