title: Early superficial temporal artery to middle cerebral artery bypass in acute ischemic stroke.
abstract: OBJECTIVE
  To evaluate the effects and safety of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in the early stage after an acute ischemic event and the improvement of present symptoms in patients with intracranial atherosclerotic occlusive disease with stroke/stroke in progress.
  
  
  METHODS
  From 2006 to 2010, 20 patients (15 males and five females) with atherosclerotic cerebrovascular disease were treated with an STA-MCA bypass. All of the patients presented with an acute ischemic stroke or stroke in progress despite maximal medical treatment. The patients underwent an STA-MCA bypass within 7 days from symptom onset. The clinical outcome and hemodynamic study of the 20 patients were preoperatively and postoperatively investigated. A pooled analysis was performed, and the results were compared with those obtained from other delayed STA-MCA bypass studies.
  
  
  RESULTS
  Among the 20 patients who underwent an early STA-MCA bypass, fourteen (70%) patients achieved a good functional outcome (mRS 0, n=3; mRS 1, n=9; mRS 2, n=2). Prior to surgery, the mean basal regional cerebral blood flow (rCBF) and cerebrovascular reserve capacity (CVR) in the symptomatic hemisphere were 37.3±4.3 ml/100 g/min and -1.68±2.9%. The mean basal rCBF and CVR had significantly increased postoperatively, and no reperfusion-induced hemorrhage had occurred. In the pooled analysis, no significant differences were observed in the clinical outcome (P=0.328) or in the incidence of postoperative complications (P=0.516) between patients who underwent an early STA-MCA bypass and in patients who underwent a delayed STA-MCA bypass in previous studies.
  
  
  CONCLUSIONS
  In this study, which consisted of 20 carefully selected patients with acute ischemic stroke, an early STA-MCA bypass was safely and effectively performed, and in some cases, an early STA-MCA bypass resulted in rapid neurological improvement. An early STA-MCA bypass was beneficial in select patients who had acute ischemic stroke with imaging evidence of a small infarction.
authors.affiliation: Department of Neurosurgery, Uijongbu St. Mary's Hospital, The Catholic University, School of Medicine, Uijongbu 480-130, Republic of Korea. leesb@catholic.ac.kr
authors.forename: Sang-Bok
authors.initials: SB
authors.lastname: Lee
authors.forename: Pil-Woo
authors.initials: PW
authors.lastname: Huh
authors.forename: Dal-Soo
authors.initials: DS
authors.lastname: Kim
authors.forename: Do-Sung
authors.initials: DS
authors.lastname: Yoo
authors.forename: Tae-Gyu
authors.initials: TG
authors.lastname: Lee
authors.forename: Kyoung-Suok
authors.initials: KS
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003627:Data Interpretation, Statistical; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020244:Infarction, Middle Cerebral Artery / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013699:Temporal Arteries / Q000601:surgery*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator