Role of Early surgical Revascularization in Acute ischemic Stroke

초록

Stroke is the one of major leading causes of death and is responsible for enormous long term disability. Dramatic evolution has been achieved in the management of acute ischemic stroke since NINDs rt-PA study. Intravenous or Intra-arterial rt-PA has become to be standard care for the patients with acute ischemic stroke and recently mechanical endovascular technique has been accepted as a standard measure as well. All of these procedures are focused on the recanalization of occluded artery and have their unique therapeutic time window. And main reason for time limitation is to prevent the hemorrhagic transformation in infracted area. However, Distinctions between recanalization and reperfusion should be noted. Several important publications relating to reperfusion for acute ischemic stroke have been published in last year. Reperfusion is a more important parameter of determining final infraction volume in acute ischemic stroke patients than recanalization. Ultimate goal of ischemic stroke management is early reperfusion of ischemic tissue. Early surgical cerebral revascularization could be another armamentarium to achieve this goal. Surgical revascularizations may have wider therapeutic time window because they could provide reperfusion without disturbing coagulation profile. Two types of surgical cerebral revascularization can be used for this purpose. One is open carotid thrombectomy and the other is STA-MCA bypass surgery. Especially, these could be a good alternative management tool for the stroke in progression. Carotid thrombectomy seems to have several limitations because it usually provides acute high flow restoration. STA- MCA bypass can be used more widely because it provides gentle reperfusion through small caliber donor artery. Early surgical revascularization strategies could broaden options for the treatment of acute stroke, but it would be apparent that selection criteria to identify ideal cases are needed to refine. Author will discuss their specific