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

Oleh:

Lee, Chang Yeob ; Kim, Chang Hyun ; Lee, Chang-Young ; Sohn, Sung-Il ; Hong, Jeong-Ho

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The Neurologist vol. 22 no. 01 (Jan. 2017), page 14-17.
Topik: Middle Cerebral Artery; Extracranial-Intracranial Arterial Bypass; Emergency Bypass; Endovascular Treatment
Fulltext: N06 v22 n1 p14 kelik2017.pdf (150.9KB)

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Perpustakaan FK Nomor Panggil: N06.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

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.

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