title: Reappraisal of Microsurgical Revascularization for Anterior Circulation Ischemia in Patients with Progressive Stroke.
abstract: BACKGROUND
  Intravenous thrombolysis using tissue plasminogen activator and endovascular treatment for acute ischemic stroke is becoming an established standard therapy. However, there is no consensus in the treatment of patients who are suffering from progressive neurologic symptoms in the later stages. The purpose of this study was to evaluate the safety and efficacy of microsurgical revascularization in such patients with progressive stroke.
  
  
  METHODS
  We retrospectively reviewed the clinical and radiological records of 14 consecutive patients with progressive stroke who underwent emergency open surgery for anterior circulation occlusion within 7 days after onset. Surgical candidates were carefully selected on the basis of symptom severity, diffusion-weighted imaging, and perfusion study. Superficial temporal artery to middle cerebral artery bypass was applied for atherosclerotic occlusion, and microsurgical embolectomy was applied for embolic occlusion.
  
  
  RESULTS
  Superficial temporal artery to middle cerebral artery bypass was performed in 12 patients, microsurgical embolectomy in 1, and the combination of these modalities in 1. As a result, complete revascularization was achieved in all patients. The National Institutes of Health Stroke Scale scores significantly improved after surgery (at third postoperative day, P < 0.05; at 14th postoperative day, P < 0.01). A favorable outcome (modified Rankin Scale 0-2) was achieved in 12 of the 14 (85.7%) patients. Minor intracerebral hemorrhage occurred in 1 patient and hyperperfusion syndrome occurred in 1 patients; however, the patients subsequently recovered without additional treatment.
  
  
  CONCLUSIONS
  Microsurgical revascularization is a feasible treatment option for patients with progressive stroke due to anterior circulation major vessel occlusion.
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Medical Center, Sapporo, Japan. Electronic address: taku-s@yk9.so-net.ne.jp.
authors.forename: Taku
authors.initials: T
authors.lastname: Sugiyama
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Kazumata
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Medical Center, Sapporo, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Asaoka
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Osanai
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Medical Center, Sapporo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shimbo
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Medical Center, Sapporo, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Uchida
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Medical Center, Sapporo, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Yokoyama
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakayama
authors.affiliation: Department of Neurosurgery, Teine Keijinkai Medical Center, Sapporo, Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Itamoto
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D017128:Embolectomy / Q000009:adverse effects; D004638:Emergency Treatment / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000601:surgery*; D020766:Intracranial Embolism / Q000150:complications / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013699:Temporal Arteries / Q000601:surgery*; D016896:Treatment Outcome
keywords: Acute ischemic stroke; EC-IC bypass; Embolectomy; Progressive stroke; STA-MCA bypass