Extracranial-intracranial (EC-IC) bypass of symptomatic middle cerebral artery (MCA) total occlusion for haemodynamic impairment patients

Chii Wen Chou, Ju Hsin Chang, Shinn Zong Lin, Der Yang Cho, Ya Wen Cheng, Chun Chung Chen

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

A retrospective, single-centre, non-randomized study in the management of symptomatic middle cerebral artery (MCA) total occlusion disease to evaluate extracranial-intracranial (EC-IC) bypass as an intervention for patients with atherosclerotic MCA total occlusion, ischemic symptoms (transient ischemic attacks [TIAs]) or poor cerebral haemodynamics who had not responded well to maximal medical treatment was reported. Twenty-three patients were included in the study with the criteria of: having ischemic syndrome, for example, TIA; being associated with atherosclerotic MCA total occlusion disease (compatible with radiological assessment); being failed to respond to optimal medical therapy (e.g. antiplatelet therapy), indicating a repeat TIA or ischemic stroke attack was noted during maximal medical therapy; having poor cerebral perfusion on CT imaging; and having regional cerebrovascular reactivity (rCVR) of <20% when acetazolamide challenge was undergone. Patients had acute ischemic stroke or other major medical co-morbidities were excluded. No patient experienced any recurrent ischemic stroke during a mean follow-up period of 26.5 months except one patient suffered of immediate post-operative ischemic stroke because of the temporal vessel being clipped too long and the hypotension caused by anaesthesia. Post-operative follow-up imaging, which included MRI (MR angiography) and four-vessel digital subtraction angiography revealed a 100% patency of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. No significant differences between observation periods (baseline status: 5.46 ± 5.13/85 ± 15; 0.5 month after surgery: 5.18 ± 5.29/85.91 ± 15.46 and 3 months after surgery: 5.09 ± 4.75/85.36 ± 12.27) were found for the neurological evaluations of NIHSS and Barthel Index (both expressed in mean ± SD) in all of the 23 patients. The annual risk of recurrent stroke was 0% after EC-IC bypass. However, studies with a larger scale are warranted to further confirm the effectiveness of EC-IC bypass. © 2012 The Neurosurgical Foundation.

Original languageEnglish
Pages (from-to)823-826
Number of pages4
JournalBritish Journal of Neurosurgery
Volume26
Issue number6
DOIs
Publication statusPublished - Dec 2012
Externally publishedYes

Fingerprint

Middle Cerebral Artery Infarction
Hemodynamics
Stroke
Transient Ischemic Attack
Temporal Arteries
Acetazolamide
Digital Subtraction Angiography
Magnetic Resonance Angiography
Middle Cerebral Artery
Therapeutics
Hypotension
Anesthesia
Perfusion
Observation
Morbidity

Keywords

  • EC-IC bypass
  • Haemodynamic impairment
  • MCA occlusion
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Extracranial-intracranial (EC-IC) bypass of symptomatic middle cerebral artery (MCA) total occlusion for haemodynamic impairment patients. / Chou, Chii Wen; Chang, Ju Hsin; Lin, Shinn Zong; Cho, Der Yang; Cheng, Ya Wen; Chen, Chun Chung.

In: British Journal of Neurosurgery, Vol. 26, No. 6, 12.2012, p. 823-826.

Research output: Contribution to journalArticle

Chou, Chii Wen ; Chang, Ju Hsin ; Lin, Shinn Zong ; Cho, Der Yang ; Cheng, Ya Wen ; Chen, Chun Chung. / Extracranial-intracranial (EC-IC) bypass of symptomatic middle cerebral artery (MCA) total occlusion for haemodynamic impairment patients. In: British Journal of Neurosurgery. 2012 ; Vol. 26, No. 6. pp. 823-826.
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