Superficial temporal artery--middle cerebral artery anastomosis for acute cerebral ischemia: the effect of small augmentation of blood flow.
In order to evaluate the effectiveness of acute cerebral revascularisation, we conducted a review of 70 patients with acute arterial occlusion or severe stenosis. Of these, 35 underwent emergency superficial temporal artery--middle cerebral artery (STA-MCA) anastomosis (surgical group) and the other 35 were treated conservatively (non-surgical group) at different times. Statistical analysis indicated that the two groups were homogeneous for the prognostic indicators. Seven days after admission, neurological symptoms and signs improved in 43% of patients in the surgical group and in 29% of the non-surgical group, however, this difference was not significant. The ratios of independent life at 3 months were 51% and 31%, respectively (not significant). Subgroup analyses indicated that final outcomes for patients with mild to moderate paresis on admission were significantly better in the surgical group than in the non-surgical group (94% vs. 53%, p < 0.01). The ratios of haemorrhagic infarction, neurological worsening, and mortality were comparable between the two groups. Time of ischaemia is a less important factor in the criteria for surgical selection. Acute revascularisation in selected patients does improve a natural course and could be a therapeutic option for acute cerebral ischaemia.
Yoshimoto
Y
Y
Neurosurgical Institute of Higashi Yokohama Hospital, Japan.
Kwak
S
S
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D003097:Collateral Circulation / Q000502:physiology; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012039:Regional Blood Flow / Q000502:physiology; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome