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.
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