Efficacy of Early Superficial Temporal Artery-Middle Cerebral Artery Double Anastomoses for Atherosclerotic Occlusion in Patients with Progressing Stroke
| Autor: | Kanehisa Kohno, Hitomi Tomita, Saya Ozaki, Shiro Ohue, Yawara Nakamura, Bungo Okuda, Kenji Kamogawa, Kensho Okamoto, Shinya Fukumoto, Haruhisa Ichikawa, Satoko Ninomiya, Shinji Onoue, Shinji Iwata, Akihiro Inoue |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Middle Cerebral Artery medicine.medical_treatment Cerebral arteries Anastomosis Revascularization Cohort Studies 03 medical and health sciences 0302 clinical medicine medicine.artery Occlusion medicine Humans Artery occlusion Aged Tomography Emission-Computed Single-Photon Cerebral Revascularization business.industry Rehabilitation Anastomosis Surgical Middle Aged Superficial temporal artery Intracranial Arteriosclerosis Surgery Temporal Arteries Stroke Diffusion Magnetic Resonance Imaging Cerebral blood flow Cerebrovascular Circulation Middle cerebral artery 030211 gastroenterology & hepatology Female Neurology (clinical) Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Magnetic Resonance Angiography |
| Zdroj: | Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 26(4) |
| ISSN: | 1532-8511 |
| Popis: | Background We investigated the efficacy of early superficial temporal artery–middle cerebral artery (STA–MCA) double anastomoses for patients with progressing stroke due to atherosclerotic occlusion. Materials and Methods Nine consecutive patients who underwent early STA–MCA double anastomoses were enrolled. All patients presented with progressing stroke despite maximal medical treatment. Cerebral blood flow in 7 patients was analyzed by single-photon emission tomography. Clinical outcomes were investigated postoperatively, and we evaluated the utility of early STA–MCA double anastomoses. Results Nine patients in the present study included those with middle cerebral artery occlusion (n = 6) and internal carotid artery occlusion (n = 3). The mean age was 58.4 years. Subjects comprised 1 female (11.1%) and 8 males (88.9%). The cause was low perfusion ischemia due to atherosclerotic occlusion with a small infarct. The mean regional cerebral blood flow (rCBF) ratio in the middle cerebral artery territory compared to the normal side was 69.6 ± 5.3%. The duration from onset to surgery was 1-8 days (median, 3.11 days). All patients underwent early STA–MCA double anastomoses, and no reperfusion-induced hemorrhage occurred. All of them slowly achieved obvious remission compared to symptoms on admission and achieved a good functional outcome. Conclusions Early STA–MCA double anastomoses were safe and effective, and early revascularization resulted in rapid neurological improvement. We recommend this procedure for patients with progressive ischemia due to main trunk artery occlusion, when the rCBF flow ratio with the normal side was 70 ± 10%, even at the subacute stage. |
| Databáze: | OpenAIRE |
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