BACKGROUND Intravenous recombinant tissue-type plasminogen activator (rt-PA) with/without endovascular treatment is sometimes not ideally effective for the treatment of acute hemodynamic stroke due to atherosclerotic major artery steno-occlusive disease, and some patients show fluctuation in or progression of symptoms despite intensive medical therapy. Urgent superficial temporal artery-middle cerebral artery (STA-MCA) bypass has been reported to be effective in patients with progressing stroke. OBJECTIVE To investigate the efficacy of urgent STA-MCA bypass performed at a single institution for progressing stroke due to hemodynamic compromise caused by atherosclerosis. METHOD We retrospectively reviewed clinical and operative records. Neurological outcomes were assessed with the modified Rankin Scale (mRS) with consideration of patient age: more than 2 points on the mRS was regarded as a poor outcome in patients under 80 years old, and more than 3 points was considered a poor outcome in those over 80 years old. The risk factors contributing to poor outcomes were evaluated. RESULTS From 2008 to 2017, 35 patients underwent urgent STA-MCA bypass for progressing stroke. The average patient age was 70.4 years (range 49-96 years). The mean National Institutes of Health Stroke Scale (NIHSS) score was 5.1 (range 0-24 points) on admission and 7.8 before surgery. After 3 months, 25 patients showed good outcomes. The preoperative NIHSS score contributed to a poor outcome (odds ratio 1.65 (95% confidence interval 1.12-2.90)). CONCLUSIONS Urgent STA-MCA bypass is a treatment option for patients with progressing stroke. The operation should be performed while the NIHSS score is low.

中文翻译：

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紧急颞浅动脉-大脑中动脉旁路术的安全性和临床结果-单机构回顾性分析。

背景技术由于动脉粥样硬化性大动脉狭窄闭塞性疾病，静脉内重组组织型纤溶酶原激活剂（rt-PA）有时不接受血管内治疗，对于急性血流动力学中风有时不是理想的治疗方法，有些患者表现出症状波动或病情进展尽管进行了深入的药物治疗。据报道，紧急的颞浅动脉-大脑中动脉（STA-MCA）旁路对进展性中风患者有效。目的探讨在单个机构中进行的紧急STA-MCA旁路治疗对由于动脉粥样硬化引起的血流动力学损害而导致中风进展的疗效。方法我们回顾性回顾了临床和手术记录。考虑到患者年龄，使用改良的兰金量表（mRS）评估了神经系统的预后：在80岁以下的患者中，mRS的2分以上被认为是较差的结果，而在80岁以上的患者中3分以上被认为是较差的结果。对导致不良结局的危险因素进行了评估。结果从2008年到2017年，有35例患者因中风进展而进行了紧急STA-MCA旁路手术。患者平均年龄为70.4岁（范围49-96岁）。美国国立卫生研究院卒中量表（NIHSS）的平均得分为入院时5.1（0-24分）和手术前7.8。3个月后，有25例患者显示出良好的预后。术前NIHSS评分导致不良预后（赔率1.65（95％置信区间1.12-2.90））。结论紧急STA-MCA旁路是中风进行性患者的治疗选择。应在NIHSS分数较低时执行该操作。