Skip to main content

Advertisement

SpringerLink
Log in

Safety and clinical outcomes of urgent superficial temporal artery-middle cerebral artery bypass—a single-institution retrospective analysis

  • Original Article - Vascular Neurosurgery - Ischemia
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Burkhardt JK, Winklhofer S, Fierstra J, Wegener S, Esposito G, Luft A, Bozinov O, Regli L (2018) Emergency extracranial-intracranial bypass to revascularize salvageable brain tissue in acute ischemic stroke patients. World Neurosurg 109:e476–e485. https://doi.org/10.1016/j.wneu.2017.10.005

    Article  PubMed  Google Scholar 

  2. Dengler R, Diener HC, Schwartz A, Grond M, Schumacher H, Machnig T, Eschenfelder CC, Leonard J, Weissenborn K, Kastrup A, Haberl R (2010) Early treatment with aspirin plus extended-release dipyridamole for transient ischaemic attack or ischaemic stroke within 24 h of symptom onset (EARLY trial): a randomised, open-label, blinded-endpoint trial. Lancet Neurol 9:159–166. https://doi.org/10.1016/s1474-4422(09)70361-8

    Article  CAS  PubMed  Google Scholar 

  3. EC/IC Bypass Study Group (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 313:1191–1200. https://doi.org/10.1056/NEJM198511073131904

    Article  Google Scholar 

  4. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329. https://doi.org/10.1056/NEJMoa0804656

    Article  CAS  PubMed  Google Scholar 

  5. Hirooka R, Ogasawara K, Inoue T, Fujiwara S, Sasaki M, Chida K, Ishigaki D, Kobayashi M, Nishimoto H, Otawara Y, Tsushima E, Ogawa A (2009) Simple assessment of cerebral hemodynamics using single-slab 3D time-of-flight MR angiography in patients with cervical internal carotid artery steno-occlusive diseases: comparison with quantitative perfusion single-photon emission CT. AJNR Am J Neuroradiol 30:559–563. https://doi.org/10.3174/ajnrA1389

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Horiuchi T, Nitta J, Ishizaka S, Kanaya K, Yanagawa T, Hongo K (2013) Emergency EC-IC bypass for symptomatic atherosclerotic ischemic stroke. Neurosurg Rev 36:559–564; discussion 564-555. https://doi.org/10.1007/s10143-013-0487-5

    Article  PubMed  Google Scholar 

  7. Hwang G, Oh CW, Bang JS, Jung CK, Kwon OK, Kim JE, Bae HJ, Han MK (2011) Superficial temporal artery to middle cerebral artery bypass in acute ischemic stroke and stroke in progress. Neurosurgery 68:723–729; discussion 729-730. https://doi.org/10.1227/NEU.0b013e318207a9de

    Article  PubMed  Google Scholar 

  8. Jovin TG, Chamorro A, Cobo E, de Miquel MA, Molina CA, Rovira A, San Roman L, Serena J, Abilleira S, Ribo M, Millan M, Urra X, Cardona P, Lopez-Cancio E, Tomasello A, Castano C, Blasco J, Aja L, Dorado L, Quesada H, Rubiera M, Hernandez-Perez M, Goyal M, Demchuk AM, von Kummer R, Gallofre M, Davalos A (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 372:2296–2306. https://doi.org/10.1056/NEJMoa1503780

    Article  CAS  PubMed  Google Scholar 

  9. Kanematsu R, Kimura T, Ichikawa Y, Inoue T (2018) Safety of urgent STA-MCA anastomosis after intravenous rt-PA treatment: a report of five cases and literature review. Acta Neurochir (Wien) 160:1721–1727. https://doi.org/10.1007/s00701-00018-03576-y

  10. Kumabe TKM, Saito R, Nagamatsu K, Sonoda Y, Higano S, Takahashi S, Tominaga T (2010) Ischemic complications associated with resection of opercular gliomas. In: Shoki T (ed) Neurovascular imaging: MRI & microangiography. Springer-Verlag, London, pp 305–318

    Google Scholar 

  11. Lee SB, Huh PW, Kim DS, Yoo DS, Lee TG, Cho KS (2013) Early superficial temporal artery to middle cerebral artery bypass in acute ischemic stroke. Clin Neurol Neurosurg 115:1238–1244. https://doi.org/10.1016/j.clineuro.2012.11.022

    Article  PubMed  Google Scholar 

  12. Lee JS, Hong JM, Lee KS, Suh HI, Demchuk AM, Hwang YH, Kim BM, Kim JS (2015) Endovascular therapy of cerebral arterial occlusions: intracranial atherosclerosis versus embolism. J Stroke Cerebrovasc Dis 24:2074–2080. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.05.003

    Article  PubMed  Google Scholar 

  13. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587. https://doi.org/10.1056/nejm199512143332401

    Article  Google Scholar 

  14. Nussbaum ES, Janjua TM, Defillo A, Lowary JL, Nussbaum LA (2010) Emergency extracranial-intracranial bypass surgery for acute ischemic stroke. J Neurosurg 112:666–673. https://doi.org/10.3171/2009.5.jns081556

    Article  PubMed  Google Scholar 

  15. Park HS, Kim SH, Nah HW, Choi JH, Kim DH, Kang MJ, Cha JK, Huh JT (2017) Patient selection and clinical efficacy of urgent superficial temporal artery-middle cerebral artery bypass in acute ischemic stroke using advanced magnetic resonance imaging techniques. Oper Neurosurg (Hagerstown) 13:552–559. https://doi.org/10.1093/ons/opx041

    Article  Google Scholar 

  16. Powers WJ, Clarke WR, Grubb RL Jr, Videen TO, Adams HP Jr, Derdeyn CP (2011) Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the carotid occlusion surgery study randomized trial. Jama 306:1983–1992. https://doi.org/10.1001/jama.2011.1610

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Saver JL, Goyal M, Bonafe A, Diener HC, Levy EI, Pereira VM, Albers GW, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, du Mesnil de Rochemont R, Singer OC, Jahan R (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 372:2285–2295. https://doi.org/10.1056/NEJMoa1415061

    Article  CAS  PubMed  Google Scholar 

  18. Shinohara Y, Yamaguchi T (2008) Outline of the Japanese guidelines for the Management of Stroke 2004 and subsequent revision. Int J Stroke 3:55–62. https://doi.org/10.1111/j.1747-4949.2008.00178.x

    Article  PubMed  Google Scholar 

  19. Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C, Wang C, Li H, Meng X, Cui L, Jia J, Dong Q, Xu A, Zeng J, Li Y, Wang Z, Xia H, Johnston SC (2013) Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 369:11–19. https://doi.org/10.1056/NEJMoa1215340

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan

    Toshikazu Kimura

  2. Department of Neurology, Tokuyama Central Hospital, Yamaguchi, Japan

    Yasumitsu Ichikawa

  3. Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan

    Tomohiro Inoue

Authors
  1. Toshikazu Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasumitsu Ichikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomohiro Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TK operated on the patients, collected the data, and wrote the manuscript. TK, YI, and TI reviewed and revised the study design. TK and TI contributed to the editing of the final manuscript.

Corresponding author

Correspondence to Toshikazu Kimura.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines were followed.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Vascular Neurosurgery - Ischemia

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kimura, T., Ichikawa, Y. & Inoue, T. Safety and clinical outcomes of urgent superficial temporal artery-middle cerebral artery bypass—a single-institution retrospective analysis. Acta Neurochir 162, 1325–1331 (2020). https://doi.org/10.1007/s00701-020-04267-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-020-04267-z

Keywords

Search

Navigation