Efficacy and Safety of Emergency Extracranial–Intracranial Bypass for Revascularization within 24 Hours in Resolving Large Artery Occlusion with Intracranial Stenosis
| Autor: | Jae-Sang Oh, Seok-Mann Yoon, Jung Ho Ko, Yun Ho Noh, Man Ryul Lee, In-Hag Song, Hae Won Koo, Jae woo Chung, Ji Young Lee |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Percutaneous medicine.medical_treatment Hemodynamics Constriction Pathologic Anastomosis Revascularization Neurosurgical Procedures Modified Rankin Scale medicine Humans Stroke Aged Retrospective Studies Cerebral Revascularization business.industry Arteries Middle Aged medicine.disease Surgery Treatment Outcome Cerebral blood flow Bypass surgery Female Neurology (clinical) business |
| Zdroj: | World Neurosurgery. 155:e9-e18 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2021.07.010 |
| Popis: | Endovascular treatment (EVT) is less effective for intracranial atherosclerosis-induced emergent large vessel occlusion. Extracranial-intracranial (EC-IC) bypass surgery is a possible treatment option to augment cerebral blood flow in the perfusion defect area. We compared the efficacy and safety of EC-IC bypass surgery with those of EVT and maximal medical treatment for acute ischemic stroke.The data from 39 patients, for whom vessel revascularization had failed despite mechanical thrombectomy, were retrospectively analyzed. Of the 39 patients, 22 had undergone percutaneous transluminal angioplasty or intracranial stenting (PTA/S), 10 had undergone emergency EC-IC bypass surgery within 24 hours of symptom onset, and 7 had received maximal medical treatment (MMT) only. The patency, perfusion status, and postoperative infarct volume were evaluated. The clinical outcomes were assessed at 6 months postoperatively using the modified Rankin scale.The mean reperfusion time was significantly longer for the EC-IC bypass group (14.9 hours) compared with that in the PTA/S group (4.1 hours) and MMT group (7.5 hours; P0.05). The postoperative infarct volume on diffusion-weighted magnetic resonance imaging was significantly lower in the emergency EC-IC bypass group (11.3 cmEmergency EC-IC bypass surgery is an effective and safe treatment option for intracranial atherosclerosis-induced acute ischemic stroke for which EVT is inadequate. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect