title: STA-MCA bypass for the treatment of ischemic stroke.
abstract: It is considered controversial whether superficial temporal artery (STA)-middle cerebral artery (MCA) bypass affects the outcome of patients with ischemic stroke. This prospective study was undertaken to demonstrate the effect of STA-MCA bypass on the cerebral blood flow and neurological status of the patients with ischemic stroke. Seventy-five patients underwent unilateral or bilateral STA-MCA bypass surgery. The selection of the patients closely adhered to the criteria of the Japan EC-IC Bypass Trial (JET). Cerebral blood flow (CBF) before and after Diamox administration was measured by single photon emission computed tomography (SPECT) using iodine-123-N-isopropyl-p-iodoamphetamine (IMP). MRI, contrast-enhanced 3D CT scans, and angiography were performed on each patient pre- and postoperatively. Bypass surgery was successfully done in all patients. CBF was significantly increased after STA-MCA bypass (P < 0.05). In addition, reservation of CBF was significantly improved after STA-MCA bypass (P < 0.05). Patients with transient ischemic attack (TIA) did not experience recurrence of such episodes after STA-MCA bypass. The neurological deficit was unchanged in patients with complete stroke after bypass surgery. However, the NIH stroke scale was significantly improved after bypass surgery (P < 0.01). In addition, the satisfaction rate of treatment as assessed by the patients themselves was very high after STA-MCA bypass (>90%) compared to the conservative treatment group (<50%). STA-MCA bypass still plays a limited role in the treatment of ischemic stroke, but may become a bright hope in depressed patients after cerebral ischemia.
authors.affiliation: Department of Neurosurgery, Suzuka Kaisei Hospital, Suzuka, Japan. kanamaru@h6.dion.ne.jp
authors.forename: Kenji
authors.initials: K
authors.lastname: Kanamaru
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Araki
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Kawakita
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Hamada
authors.forename: Hideki
authors.initials: H
authors.lastname: Kanamaru
authors.forename: Keita
authors.initials: K
authors.lastname: Matsuura
authors.forename: Akitoshi
authors.initials: A
authors.lastname: Sato
authors.forename: Hidenori
authors.initials: H
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D007291:Inosine Monophosphate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D007291:Inosine Monophosphate