Efficacy and Safety of Emergency Extracranial–Intracranial Bypass for Revascularization within 24 Hours in Resolving Large Artery Occlusion with Intracranial Stenosis

Noh, Yun Ho; Chung, Jaewoo; Ko, Jung Ho; Koo, Hae-Won; Lee, Ji Young; Yoon, Seok-Mann; Song, In-Hag; Lee, Man Ryul; Oh, Jae Sang

doi:10.1016/j.wneu.2021.07.010

Cited by 5 publications

(4 citation statements)

References 55 publications

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“…A total of seven studies [ 15 , 16 , 21 – 25 ] reported the clinical efficacy of urgent STA-MCA bypass in AIS. Meta-analysis revealed that the good outcome rate for urgent STA-MCA in AIS treatment was 67% (95% CI: 57%–77%), with no significant heterogeneity (I 2 = 44.1%, p = 0.097) across the studies, indicating that early STA-MCA bypass in AIS has a moderately high good outcome rate (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass surgery is typically recognized for its role in preventing brain infarction and reducing hemorrhage risk by enhancing cerebral hemodynamics in patients with steno-occlusive cerebrovascular diseases [ 14 ]. Recent studies have indicated that urgent STA-MCA bypass can reduce infarct size, enhance neurological function, improve quality of life, and lower mortality in AIS patients who are ineligible for or have failed EVT [ 15 , 16 ]. However, none of these studies have specifically addressed the impact of urgent STA-MCA bypass in resolving AIS-LVO in patients with a relatively high National Institutes of Health Stroke Scale (NIHSS) score during the acute phase.…”

Section: Introductionmentioning

confidence: 99%

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The clinical outcome of emergency superficial temporal artery-to-middle cerebral artery bypass in acute ischemic stroke with large vessel occlusion

Guo,

Yang,

et al. 2024

Neurosurg Rev

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The role of superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass in acute ischemic stroke (AIS) is contentious, with no evidence in patients with AIS and large vessel occlusion (AIS-LVO). We conducted a cohort study to assess emergency STA-MCA outcomes in AIS-LVO and a meta-analysis to evaluate STA-MCA outcomes in early AIS treatment. From January 2018 to March 2021, we consecutively recruited newly diagnosed AIS-LVO patients, dividing them into STA-MCA and non-STA-MCA groups. To evaluate the neurological status and outcomes, we employed the National Institutes of Health Stroke Scale (NIHSS) during the acute phase and the modified Rankin Scale (mRS) during the follow-up period. Additionally, we conducted a meta-analysis encompassing all available clinical studies to assess the impact of STA-MCA on patients with AIS. In the cohort study (56 patients), we observed more significant neurological improvement in the STA-MCA group at two weeks (p = 0.030). However, there was no difference in the clinical outcomes between the two groups. Multivariable logistic regression identified the NIHSS at two weeks (OR: 0.840; 95% CI: 0.754–0.936, p = 0.002) as the most critical predictor of a good outcome. Our meta-analysis of seven studies indicated a 67% rate for achieving a good outcome (mRS < 3) at follow-up points (95% CI: 57%–77%, I2 = 44.1%). In summary, while the meta-analysis suggested the potential role of STA-MCA bypass in mild to moderate AIS, our single-center cohort study indicated that STA-MCA bypass does not seem to improve the prognosis of patients who suffer from AIS-LVO.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The clinical outcome of emergency superficial temporal artery-to-middle cerebral artery bypass in acute ischemic stroke with large vessel occlusion

Guo,

Yang,

et al. 2024

Neurosurg Rev

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“…The available data indicate a relatively good safety profile and efficacy of this treatment (4,5). Acute ECIC bypass in very well-selected patients with ICA occlusion improves the chance of a good clinical outcome (6).…”

Section: Et Al Report Early Stent Restenosis In 19% Of Cases In Ais (...mentioning

confidence: 99%

Case report: Combined acute revascularization in early bilateral carotid stent occlusion

Černík

Bartoš²,

Neradová

et al. 2022

Front. Neurol.

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IntroductionThe introduction of a carotid stent involves the use of effective antiplatelet therapy to maintain stent patency. We present a case report of combined acute revascularization in a patient with occlusion in recently introduced stents of both carotid arteries.MethodsThe patient (male, 73 years) was admitted for stroke recurrence upon discontinuation of antiplatelet therapy. According to the CTA, the closure of implanted stents of both carotid arteries was confirmed. Intravenous thrombolysis and mechanical thrombectomy were performed with complete recanalization of the left carotid stent. At 3 days apart, clinical deterioration was found with progressive stent restenosis. Percutaneous transluminal stent angioplasty, mechanical embolectomy and prolonged low-dose intravenous thrombolysis have been used repeatedly.ResultsWith the impossibility of maintaining the patency of carotid stents even on the maximum drug therapy and despite endovascular procedures, bilateral neurosurgical revascularization of the middle cerebral arteries using ECIC bypasses was successfully performed. Prolonged low-dose intravenous thrombolysis (20 mg recombinant plasminogen aktivator (rTPA)/10 h) has proven to be an acute bridging therapy until surgery.ConclusionEarly occlusion of the carotid stent is a significant complication of endovascular treatment of stenotic arteries. ECIC bypass revascularization of the middle cerebral artery can be a highly effective therapeutic procedure.

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“…Nevertheless, the available data point toward beneficial effects of EVT in later time windows up to 24 h. However, patients may present after more than 24 h after last-seen-well or even after symptoms have been definitively recognized, for various reasons. For patients with progressive stroke or relevant tissue-at-risk 8 and large-vessel occlusion (LVO), causal treatment options despite an increase in blood pressure have not been established in prolonged time windows of more than 24 h. Small studies advocate for emergency extracranial-intracranial bypass surgery, 9,10 but other studies, including one randomized controlled trial (RCT) enrolling patients beyond 24 h of symptom onset, raised safety and futility concerns. 11,12 Recently, case series and observational studies reported that EVT was effective in patients more than 24 h after last-seen-well or definitive symptom onset, but treatment was limited to highly selected patients with anterior circulation stroke.…”

Section: Introductionmentioning

confidence: 99%

Leaving the day behind: endovascular therapy beyond 24 h in acute stroke of the anterior and posterior circulation

Purrucker

Ringleb

Şeker

et al. 2022

Ther Adv Neurol Disord

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Background: There is little evidence of endovascular therapy (EVT) being performed in acute ischemic stroke beyond 24 h, and that evidence is limited to anterior circulation stroke. Objective: To extend evidence of efficacy and safety of EVT after more than 24 h in both anterior and posterior circulation stroke. Methods: Local, prospectively collected registries were screened for patients with acute ischemic stroke and large-vessel occlusion who had received either EVT > 24 h after last-seen-well but <24 h after symptom recognition (EVT>24LSW) or EVT > 24 h since first (definitive) symptom recognition (EVT>24DEF). Patients treated <24 h served as a group for comparison. Favorable outcome was defined as modified Rankin scale (mRS) 0–2 or return to prestroke mRS at 3 months. Results: Between January 2014 and August 2021, N = 2347 were treated with EVT at our comprehensive stroke center, of whom n = 43 met the inclusion criteria (EVT>24LSW, n = 16, EVT>24DEF, n = 27). EVT>24LSW patients were treated at a median of 28.7 h [interquartile range (IQR) = 27.3–32.8] after last-seen-well and 7.3 h (IQR = 2.8–14.3) after symptom recognition; EVT>24DEF patients were treated 52.5 h (IQR = 26.5–94.2) after first symptoms. Favorable outcome was achieved by 23.3% (10/43) in the EVT > 24 compared with 39.4% (886/2250) in the EVT < 24 group ( p = 0.04). Bleeding rates were similar across groups. Mortality was also similar [EVT > 24, 27.9% (12/43) versus EVT < 24, 25.7% (584/2264), p = 0.727; posterior circulation, EVT > 24, 41.7% (5/12) versus EVT < 24, 36.5% (92/252) p = 0.764]. Conclusion: In selected patients, EVT seems effective and safe beyond 24 h for both anterior and posterior circulation stroke.

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Efficacy and Safety of Emergency Extracranial–Intracranial Bypass for Revascularization within 24 Hours in Resolving Large Artery Occlusion with Intracranial Stenosis

Cited by 5 publications

References 55 publications

The clinical outcome of emergency superficial temporal artery-to-middle cerebral artery bypass in acute ischemic stroke with large vessel occlusion

The clinical outcome of emergency superficial temporal artery-to-middle cerebral artery bypass in acute ischemic stroke with large vessel occlusion

Case report: Combined acute revascularization in early bilateral carotid stent occlusion

Leaving the day behind: endovascular therapy beyond 24 h in acute stroke of the anterior and posterior circulation

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