First experience of low-flow extra-intracranial bypass surgery in patients with acute ischemic stroke

Low flow EC–IC bypass is the operation of reserve, which can approve recovery for patients with occlusion of ICA and failure of endovascular revascularization methods in acute phase of ischemic insult.

THE PURPOSE OF THE STUDY was improvement of treatment results of patients with ICA occlusion and acute ischemic insult with help of early EC–IC bypass between external temporal artery and M4 brunches.

MATERIALS AND METHODS. 8 patients (7 man and 1 women) 55–75 years age, were treated with EC–IC bypass in first 5–14 days of acute ischemic insult. Doppler M1 flow assessment, ASPECTS score, penumbra zone changes, NIHSS and mRS scores were compared before and 1 month after surgery.

RESULTS. All anastomoses were parent. In 2 cases 10 % enlargement of ischemic area were seen the next day after surgery without neurological worsening. One patient with wide penumbra zone have shown malignant hemisphere ischemia at the third day after surgery, and required emergent hemisphere decompression. In other case, the new ischemic areas were seen in the basal ganglia and contralateral hemisphere after the acute myocardial infarction onset at the second postoperation day. One acute subdural hematoma emergent evacuation was performed in one case. The M1 flow was normalized at the 14 day after operation in 75 % of patients. Two deaths were registered because of somatic pathology progression. 5 patients were released from the hospital with slight improvement up to 6–7 points in NIHSS score. mRS were 1–2 points in 5 cases, and 4 points in one.

CONCLUSION. Early EC–IC bypass in acute ischemic insult doesn’t lead to quickly neurological recovery of patient. Low-flow EC–IC bypass with M4 brunches is the additional source of collateral blood flow, and gives no meaningful protection of cerebral parenchyma in case of cerebral perfusion pressure drop during acute ischemic insult.

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