Clinical significance of STA-MCA double anastomosis for hemodynamic compromise in post-JET/COSS era

Abstract

STA-MCA "double" anastomosis may still have the potential to reduce the risk of recurrent ipsilateral stroke in hemodynamically compromised patients. Further studies would be essential to advance diagnosis, surgical procedures, and perioperative managements to bring out maximal effects of bypass surgery.

Progressive Cortical Neuronal Damage and Extracranial-Intracranial Bypass Surgery in Patients with Misery Perfusion

“…29 Cerebral hyperperfusion after carotid endarterectomy was found to result in a decrease in BZRs. 17 To prevent perioperative neuronal damage, therapeutic strategies that limit selective neuronal damage, including careful perioperative management 30 and the use of neuroprotective agents, 31,32 may be needed for patients with MP. Furthermore, MP may not improve completely or immediately after bypass surgery.…”

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

“…41 The Japanese EC-IC Bypass Trial (JET) was a multicenter RCT designed to assess whether STA-MCA bypass (plus best medical therapy) is superior to best medical therapy alone in reducing subsequent ischemic events in patients with recently symptomatic hemodynamic (at least stage-I on single-photon emission computed tomography; Figure 3) cerebral ischemia from chronic ICA or MCA occlusion. [42][43][44] One hundred ninetysix patients were enrolled and randomized 50:50. 28,42,44 An interim analysis with a mean follow-up of 15 months reported a statistically significant reduction of major stroke and death (primary outcome) in the surgical arm (5.1%) when compared with the medical one (14.3%).…”

“…28,42,44 An interim analysis with a mean follow-up of 15 months reported a statistically significant reduction of major stroke and death (primary outcome) in the surgical arm (5.1%) when compared with the medical one (14.3%). 43,44 The published Kaplan-Meier curve shows, however, no end points within the first month in the surgical group: it is not mentioned if the results include the morbidity and mortality rate of the first postoperative month. 28,43,44 As commented by Powers et al 5 , it seems unlikely that this rate was 0%, given that it was 12% in the original EC-IC Bypass Trial and 15% in the COSS.…”

“…43,44 The published Kaplan-Meier curve shows, however, no end points within the first month in the surgical group: it is not mentioned if the results include the morbidity and mortality rate of the first postoperative month. 28,43,44 As commented by Powers et al 5 , it seems unlikely that this rate was 0%, given that it was 12% in the original EC-IC Bypass Trial and 15% in the COSS. JET final results have not yet been published in a peer-reviewed, English written journal.…”

Perfusion criteria of the EICMA efficacy in patients with symptomatic occlusion of the internal carotid artery

“…Изменения церебральной гемодинамики -один из наиболее значимых факторов, определяющих прогноз симптоматической окклюзии артерий ка-ротидного бассейна [2]. Внедрение в клиническую практику доступных современных методов опреде-ления церебральной перфузии позволяет более де-тально исследовать изменения мозгового кровотока до и после оперативного вмешательства, тем самым уточняя роль гемодинамических факторов в про-гнозировании эффективности ЭИКМА [3,4].…”