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Urgent Bypass Surgery Following Failed Endovascular Treatment in Acute Symptomatic Stroke Patient With MCA Occlusion

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Author(s)
Lee, Chang YeobKim, Chang HyunLee, Chang-YoungSohn, Sung-IlHong, Jeong-Ho
Keimyung Author(s)
Sohn, Sung IlHong, Jeong HoLee, Chang YoungKim, Chang Hyun
Department
Dept. of Neurology (신경과학)
Journal Title
Neurologist
Issued Date
2017
Volume
22
Issue
1
Keyword
middle cerebral arteryextracranial-intracranial arterial bypassemergency bypassendovascular treatmentsuperficial temporal artery to middle cerebral artery bypass
Abstract
Introduction: Although the benefits of extracranial-intracranial bypass surgery remain controversial, there is some surgical rationale for the augmentation of cerebral blood flow in cases of acute ischemic stroke with hemodynamic instability.

Case Report: We report a case of a 62-year-old woman who suddenly developed right hemiplegia and global aphasia. Initial magnetic resonance imaging and magnetic resonance angiography revealed a small acute ischemic lesion in left parietal lobe with occlusion at the left middle cerebral artery. We performed an endovascular thrombectomy, which failed. Her neurological deficits remained unchanged. On the basis of immediate postendovascular magnetic resonance perfusion, diffusion-weighted imaging (DWI), and neurological examination, an obvious clinical-DWI and a DWI–perfusion-weighted imaging mismatch were detected. We decided to perform emergency superficial temporal artery to middle cerebral artery bypass to prevent further progression of cerebral ischemia. On a 3-month follow-up, neurological deficits remained minimal motor aphasia and dysarthria.

Conclusions: Following failed endovascular treatment in patients with acute symptoms attributed to major cerebral artery occlusion, we recommend immediate multimodal neuroimaging. If there are clinical-DWI and DWI–perfusion-weighted imaging mismatch indications, surgical revascularization could be considered as the next salvageable strategy.
Keimyung Author(s)(Kor)
손성일
홍정호
이창영
김창현
Publisher
School of Medicine
Citation
Lee, Chang Yeob et al. (2017). Urgent Bypass Surgery Following Failed Endovascular Treatment in Acute Symptomatic Stroke Patient With MCA Occlusion. Neurologist, 22(1), 14–17. doi: 10.1097/NRL.0000000000000086
Type
Article
ISSN
1074-7931
Source
https://journals.lww.com/theneurologist/Fulltext/2017/01000/Urgent_Bypass_Surgery_Following_Failed.2.aspx
DOI
10.1097/NRL.0000000000000086
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/32829
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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