Superficial Temporal Artery to Middle Cerebral Artery Cranial Bypass for Nonmoyamoya Steno-Occlusive Disease in Patients Who Failed Optimal Medical Treatment: A Case Series. Issue 5 (20th January 2021)

• Record Type: Journal Article
• Authors: Haynes, Joseph; Kronenburg, Annick; Raz, Eytan; Rostanski, Sara; Yaghi, Shadi; Ishida, Koto; Shapiro, Maksim; Nelson, Peter Kim; Tanweer, Omar; Langer, David J; Riina, Howard A; Eichel, Roni; Nossek, Erez
• Is Part Of: Operative neurosurgery. Volume 20:Issue 5(2021)
• Page Start: 444
• Page End: 455
• Publication Date: 2021-01-20
• Subjects: Bypass -- Cerebral revascularization surgery -- Extracranial-intracranial bypass -- Middle cerebral artery -- Superficial temporal artery; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opaa458
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: BACKGROUND: In the post-Carotid Occlusion Surgery Study (COSS) era, multiple reviews suggested subset groups of patients as potential candidates for superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Among them are patients with recurrent strokes despite optimal medical therapy. There is a paucity of data on the outcome of bypass in these specific patients. OBJECTIVE: To examine the safety and efficacy of direct STA-MCA bypass in patients with nonmoyamoya, symptomatic steno-occlusive disease with impaired distal perfusion, who failed optimal medical management or endovascular treatment. METHODS: A retrospective review was performed to identify patients with cerebrovascular steno-occlusive disease who underwent bypass after symptomatic recurrent or rapidly progressive strokes, despite optimal conservative or endovascular treatment. RESULTS: A total of 8 patients (mean age 60 ± 6 yr) underwent direct or combined direct/indirect STA-MCA bypass between 2016 and 2019. All anastomoses were patent. One bypass carried slow flow. There were no procedure-related permanent deficits. One patient developed seizures which were controlled by medications. A total of 7 out of 8 patients were stable or improved clinically at last follow-up (mean 27.3 ± 13.8 mo) without recurrent strokes. One patient did not recover from their presenting stroke, experienced severe bilateral strokes 4 mo postoperatively, and subsequently expired. Modified Rankin Scale (mRS) improved in 6 patients (75%), remained stable in 1 patient (12.5%), and deteriorated in 1 (12.5%). Good long-term functional outcome was achieved in 5 patients (63%, mRS ≤ 2). CONCLUSION: Patients with symptomatic, hypoperfused steno-occlusive disease who fail optimal medical or endovascular treatment may benefit from cerebral revascularization. Direct or combined STA-MCA bypass was safe and provided favorable outcomes in this small series.