Extracranial–intracranial (EC–IC) bypass of symptomatic middle cerebral artery (MCA) total occlusion for haemodynamic impairment patients

Abstract

A retrospective, single-centre, non-randomized study in the management of symptomatic middle cerebral artery (MCA) total occlusion disease to evaluate extracranial-intracranial (EC-IC) bypass as an intervention for patients with atherosclerotic MCA total occlusion, ischemic symptoms (transient ischemic attacks [TIAs]) or poor cerebral haemodynamics who had not responded well to maximal medical treatment was reported. Twenty-three patients were included in the study with the criteria of: having ischemic syndrome, for example, TIA; being associated with atherosclerotic MCA total occlusion disease (compatible with radiological assessment); being failed to respond to optimal medical therapy (e.g. antiplatelet therapy), indicating a repeat TIA or ischemic stroke attack was noted during maximal medical therapy; having poor cerebral perfusion on CT imaging; and having regional cerebrovascular reactivity (rCVR) of <20% when acetazolamide challenge was undergone. Patients had acute ischemic stroke or other major medical co-morbidities were excluded. No patient experienced any recurrent ischemic stroke during a mean follow-up period of 26.5 months except one patient suffered of immediate post-operative ischemic stroke because of the temporal vessel being clipped too long and the hypotension caused by anaesthesia. Post-operative follow-up imaging, which included MRI (MR angiography) and four-vessel digital subtraction angiography revealed a 100% patency of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. No significant differences between observation periods (baseline status: 5.46 ± 5.13/85 ± 15; 0.5 month after surgery: 5.18 ± 5.29/85.91 ± 15.46 and 3 months after surgery: 5.09 ± 4.75/85.36 ± 12.27) were found for the neurological evaluations of NIHSS and Barthel Index (both expressed in mean ± SD) in all of the 23 patients. The annual risk of recurrent stroke was 0% after EC-IC bypass. However, studies with a larger scale are warranted to further confirm the effectiveness of EC-IC bypass.

Efficacy of Surgical Revascularizations in Young and Middle-aged Patients with Symptomatic Middle Cerebral Arterial Occlusion

“…(4,6,12,20) With strict hemodynamic criteria, direct revascularization could help preventing SIE. (21) In contrast, SIE occurred in 29.4% of patients receiving direct revascularization in our study. It is a higher incidence than that from Low et al and JET-2, which is 13% and 8.3%, respectively.…”

Endovascular revascularization of symptomatic chronic middle cerebral artery occlusions: Two case reports

“…No recurrent stroke events were reported during a mean follow-up of 26.5 months. 6 For endovascular revascularization of chronic MCA occlusions, there were two prior reports. Mori et al.…”

“…No recurrent stroke events were reported during a mean follow-up of 26.5 months. 6 For endovascular revascularization of chronic MCA occlusions, there were two prior reports. Mori et al reported a 100% revascularization rate for angioplasty for three patients with Mori type B lesions (total occlusions less than or equal to three months old), and 33% for three patients with type C lesions (total occlusions more than three months old, more than 10 mm long or with extreme angulation), 7 while Ma et al reported two successful stentings.…”

Extracranial to intracranial by-pass anastomosis: Review of our preliminary experience from a low volume center in Egypt

“…Extracranial-to-intracranial (EC-IC) by-pass, either for flow augmentation or replacement, is an important tool in the armamentarium of practicing vascular and skull base surgeons. [ 1 2 3 4 ] Ever since it was introduced by Yasargil in 1967, it has become an indispensible tool for managing patients with hemodynamic ischemia, or for managing patients with complex aneurysms or skull base tumors; that are not amenable to radical resection; because of major vascular involvement. [ 5 6 7 8 9 ] Patients with hemodynamic ischemia have an annual stroke rate of 25% which increases by 2% every year.…”