Current Status of Early Surgical Revascularization in Acute Ischmic Stroke Abstract

초록

Introduction : To Evaluate the Role and Feasibility of Early Surgical Revascularization in Patients with Acute Hemispheric Ischemic Stroke Material and Method : We reviewed medical records and radiological data of 28 patients who experienced the stroke in progression or unstable neurological status after admission and had undergone surgical revascularization surgery. All patients had cerebral infarction relating with middle cerebral artery or internal carotid artery occlusion. We evaluated their immediate preoperative, postoperative, and final NIHSS score and investigated the progression of cerebral infarction in postoperative imaging compared to the preoperative imaging. Results : Patients were 8 men and 4 women. Mean age was 67 (Age range; 58-82 years) Revascularization surgeries (11 Carotid artery thrombectomy and 14 STA-MCA bypass surgery, 3 microembolectomy) have been performed between 8 hours and 72 hours after onset of symptom. All surgeries have got successful revascularization radiolologically. Twelve patients had improvement in NIHSS score immediately after surgery, twelve patients showed stop of neurological progression and four patients showed neurological aggravation. Progression of cerebral infarction has been shown in seven patients on postoperative radiological imaging, however, aggravation of NIHSS score has indentified in four of them. Delayed hemorrhagic transformations after surgery have been identified in four patients (two after carotid thrombectomy and two after STA-MCA bypass). Two of them have affected the worsening of NIHSS score. One Delayed ICH has occurred in one patient who had received carotid thrombectomy. Spontaneous recanalization of previous occluded middle cerebral artery has been observed in two patients after STA-MCA bypass surgery. Delyaed contralateral cerebral infarction due to cardiac embolis has occurred in one patient. Conclusions : Early Surgical revascularization could be considered in patients with stroke in evolution o