Role of early surgical revascularization in patients with ischemic stroke in evloution

초록

PURPOSE : To evlaute the role and feasibility of early surgical revascularization in patients with sroke in evolution MATERIALS AND METHODS : We reviewed medical records and radiological datas of 12 patients who experienced the stroke in progression or unstable neurological status after admission and had undergone surgical revascularization surgery. All patient had cerebral infarction relating with middle cerebral artery or intrenal 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 ( 4 Carotid endarterectomy and 8 STA-MCA bypass surgery) have been performed between 10 hours and 72 hours after onset of symptom. All surgeries have got successful revascularization radiolologically. Three patients had improvement in NIHSS score immediately after surgery, seven patients showed stop of neurological progression and two patients showed neurological aggravation. Progression of cerebral infarction has been shown in four patients on postoperative radiological imaging, however, aggravation of NIHSS score has idenfieid in only one of them. Two delyayed hemorrhagic infarctions have developed after surgery (one after CEA and one after STA-MCA bypass). Spontaneous recanalization of previous occulded middle cerebral artery has been observed in patinets with hemorrhagic infarction developed after STA-MCA bypass surgery. Delyaed contralateral cerebral infarction due to cardiac embolis has occurred in one patients. CONCLUSION : Early Surgical revascularization could be considered in patients with stroke in evolution or unstable neurological status with severe mismatch hemodynamic nature. STA-MCA bypass, which could provide enhancing downstream collaterals, could be used more safely and effectively in cas