Superficial temporal artery to middle cerebral artery bypass in acute ischemic stroke and stroke in progress

Abstract

BACKGROUND: Surgical reperfusion may be beneficial in patients with acute ischemic stroke who are ineligible for thrombolysis. OBJECTIVE: To evaluate the outcome of superficial temporal artery to middle cerebral artery (STA-MCA) bypass in acute stroke and stroke in progress. METHODS: The clinical and radiological data of 9 patients treated by STA-MCA bypass requiring urgent reperfusion but ineligible for intra-arterial thrombolysis (IAT) were reviewed. Pooled analysis was performed of published literature concerning STA-MCA bypass in acute stroke (21 cases in 2 articles). RESULTS: Of the 9 patients enrolled, symptom aggravation occurred during medical treatment in 4 patients and after IAT in 2. Three patients were ineligible for IAT despite being within 8 hours of symptom onset. Bypass significantly improved National Institutes of Health Stroke Scale scores (preoperatively, 12.4 +/- 4.88; 3 days postoperatively, 8.6 +/- 6.39, P =.046; discharge, 5.4 +/- 5.15, P =.008; 3 mo postoperatively 3.7 +/- 4.82, P =.008) without significant infarction growth by diffusion weighted imaging (preoperatively, 15.0 +/- 8.87 mL; 7 days postoperatively, 15.2 +/- 8.28 mL; P =.110). Abnormal perfusion regions (mean transit time >145% of contralateral side value) were reduced in all cases (2.63 +/- 0.93 mL). Good outcomes (modified Rankin scale <= 2) were achieved by 6 patients. Pooled analysis with our patients showed a significant neurological improvement (P <.001) and a good outcome in 25 (83.3%) patients without hemorrhage or complication. CONCLUSION: STA-MCA bypass may be beneficial to patients with acute stroke or stroke in progress who are ineligible for IAT. Furthermore, it appears safe when the infarction is small. These findings indicate that STA-MCA bypass could be considered as a treatment option in selected patients with acute stroke or stroke in progress.