Current role of 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 became 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. Main reason for time limitation is to prevent the hemorrhagic transformation in infracted area. 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 can provide reperfusion without disturbing coagulation profile. Especially, these are good alternative for managing stroke in progression. Two types of surgical cerebral revascularization can be used for this purpose. One is carotid thromboembolectomy and the other one is STA-MCA bypass surgery. Carotid thromboembolectomy seems to have several limitations because it usually provides high flow restoration. STA- MCA bypass can be used more widely because it provides gentle reperfusion through small caliber donor artery. Author will discuss their specific indication and their role in management of acute ischemic stoke.