Bypass surgery for ischemic stroke caused by intracranial artery stenosis or occlusion

Surgical revascularization may be beneficial in patients with ischemic stroke caused by intracranial stenosis or occlusion who are ineligible for thrombolysis. Objective: To evaluate the outcome of superficial temporal artery to middle cerebral artery(STA-MCA) bypass in ischemic stroke caused by intracranial artery stenosis or occlusion. Methods: We retrospectively studied successive case series of 19 patients who underwent surgical treatment between 2013–2017 of STA-MCA bypass. Surgical procedure was performed for the patients with acute ischemic stroke who were ineligible for thrombolysis. Results: Of the 19 patients enrolled, symptom aggravation occurred during medical treatment, the patients were ineligible for thrombolysis despite being within 8 hours of symptom onset. Bypass significantly improved National Institutes of Health Stroke Scale scores, mean patient age was 78.05 years(range, 39-78 y). However, male 11(57.95%)out of nineteen patients were presented with left-sided-lesions while female 8(42%) had right-sided lesions with significant infarction growth by diffusion weighted imaging achieved, after surgical maneuver. No major complications occurred intraoperatively, in contrast to 2(10.5%) minor manifestation were suffering minor complications probably they included the remote infarction(posterior cerebral artery territory). Pooled analysis with our patients showed a significant neurological improvement and a good outcome in 13(68.4%) patients without hemorrhage or any other complication, 6(31.6%) patients with unfavorable outcome(severe disability 2; vegetative state 4, non of them are died 0;). Conclusion: STA-MCA bypass may be beneficial to patients with acute stroke or stenosis in progress who are ineligible for medical therapy. 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 ischemic stroke caused by intracranial stenosis or occlusion.