STA-MCA Bypass for the Treatment of Ischemic Stroke

Abstract

It is considered controversial whether superficial temporal artery (STA)-middle cerebral artery (MCA) bypass affects the outcome of patients with ischemic stroke. This prospective study was undertaken to demonstrate the effect of STA-MCA bypass on the cerebral blood flow and neurological status of the patients with ischemic stroke. Seventy-five patients underwent unilateral or bilateral STA-MCA bypass surgery. The selection of the patients closely adhered to the criteria of the Japan EC-IC Bypass Trial (JET). Cerebral blood flow (CBF) before and after Diamox administration was measured by single photon emission computed tomography (SPECT) using iodine-123-N-isopropyl-p-iodoamphetamine (IMP). MRI, contrast-enhanced 3D CT scans, and angiography were performed on each patient pre- and postoperatively. Bypass surgery was successfully done in all patients. CBF was significantly increased after STA-MCA bypass (P < 0.05). In addition, reservation of CBF was significantly improved after STA-MCA bypass (P < 0.05). Patients with transient ischemic attack (TIA) did not experience recurrence of such episodes after STA-MCA bypass. The neurological deficit was unchanged in patients with complete stroke after bypass surgery. However, the NIH stroke scale was significantly improved after bypass surgery (P < 0.01). In addition, the satisfaction rate of treatment as assessed by the patients themselves was very high after STA-MCA bypass (>90%) compared to the conservative treatment group (<50%). STA-MCA bypass still plays a limited role in the treatment of ischemic stroke, but may become a bright hope in depressed patients after cerebral ischemia.

Neurocognitive Improvement After Carotid Artery Stenting in Patients With Chronic Internal Carotid Artery Occlusion

“…Transient ischemia attack was seen in approximately one-third (13 of 40, 32.5%) of the patients, hemiplegia in about two-thirds (27 of 40, 67.5%) of the patients, and dysphasia in 30% (12 of 40) of the patients. The mean admission NIHSS score was 6.40 + 2.86 (range, 2-13), and the mean MoCA score was 14.80 + 3.43 (range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Occlusion was noted in the right ICA in 5 (12.5%) patients, in the left ICA in 33 (82.5%) patients, and bilateral ICA in 2 (5%) patients.…”

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%).…”

“…[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%). 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.…”

“…3) церебральной ишемией по причине хронической окклюзии ВСА или СМА [42][43][44]. В испытание зачислили 196 паци-ентов и рандомизировали в соотношении 50:50 [28,42,44].…”

“…3) церебральной ишемией по причине хронической окклюзии ВСА или СМА [42][43][44]. В испытание зачислили 196 паци-ентов и рандомизировали в соотношении 50:50 [28,42,44]. По данным промежуточного анализа, при средней продолжительности периода наблюдения 15 месяцев сообщили о статистически значимом снижении частоты развития тяжелого инсульта или смерти (первичная конечная точка) в группе хирур-гического лечения (5,1%) по сравнению с медика-ментозным лечением (14,3%) [43,44].…”