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Delayed microsurgical revascularization in an acute ischemic stroke based on perfusion study

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Abstract

A 58-year-old patient presented with a severe neurological deficit due to a stroke caused by an occlusion of the left internal carotid artery siphon. Standard treatment failed and neurosurgical consult was delayed. Because of a favorable perfusion imaging finding, microsurgical revascularization via an extra-intracranial bypass (left superficial temporal artery — left middle cerebral artery) was performed 36 hours after the onset of the symptoms. The outcome of the patient was favorable. The authors want to emphasize the need to actively seek patients with a severe neurological deficit and still viable brain tissue. The time window and treatment alternatives are discussed.

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Data availability

The additional data are available from the corresponding author upon reasonable request.

References

  1. Amin-Hanjani S, Du X, Mlinarevich N et al (2005) The cut flow index: an intraoperative predictor of the success of extracranial-intracranial bypass for occlusive cerebrovascular disease. Neurosurgery 56:75–85 discussion 75-85

    PubMed  Google Scholar 

  2. Campbell BC, Christensen S, Levi CR et al (2012) Comparison of computed tomography perfusion and magnetic resonance imaging perfusion-diffusion mismatch in ischemic stroke. Stroke 43:2648–2653

    Article  PubMed  Google Scholar 

  3. Diaz FG, Ausman JI, Mehta B et al (1985) Acute cerebral revascularization. J Neurosurg 63:200–209

    Article  CAS  PubMed  Google Scholar 

  4. Fiedler J, Roubec M, Grubhoffer M et al (2022) Emergent microsurgical intervention for acute stroke after mechanical thrombectomy failure: a prospective study. J Neurointerv Surg

    Google Scholar 

  5. Grubb RL Jr, Powers WJ, Clarke WR et al (2013) Surgical results of the carotid occlusion surgery study. J Neurosurg 118:25–33

    Article  PubMed  Google Scholar 

  6. Kanematsu R, Kimura T, Ichikawa Y et al (2018) Safety of urgent STA-MCA anastomosis after intravenous rt-PA treatment: a report of five cases and literature review. Acta Neurochir (Wien) 160:1721–1727

    Article  PubMed  Google Scholar 

  7. Lee CY, Kim CH, Lee CY et al (2017) Urgent bypass surgery following failed endovascular treatment in acute symptomatic stroke patient with MCA occlusion. Neurologist 22:14–17

    Article  PubMed  Google Scholar 

  8. Ma H, Campbell BCV, Parsons MW et al (2019) Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. N Engl J Med 380:1795–1803

    Article  PubMed  Google Scholar 

  9. Mracek J, Mork J, Stepanek D et al (2013) Urgent extracranial-intracranial bypass in the treatment of acute hemodynamic ischemic stroke: case report. J Neurol Surg A Cent Eur Neurosurg 74:325–331

    Article  PubMed  Google Scholar 

  10. Ngo HM, Trinh HT, Felbaum R et al (2022) Emergency extra-intracranial bypass surgery in a patient with neurologic deficit after an accident in carotid occlusive test: a case report. Int J Surg Case Rep 94:107071

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nogueira RG, Jadhav AP, Haussen DC et al (2018) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378:11–21

    Article  PubMed  Google Scholar 

  12. Nussbaum ES, Janjua TM, Defillo A et al (2010) Emergency extracranial-intracranial bypass surgery for acute ischemic stroke. J Neurosurg 112:666–673

    Article  PubMed  Google Scholar 

  13. Reed M, Kerndt CC, Nicolas D. Alteplase (2023) In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499977/

  14. Sebök M, Esposito G, Niftrik CHBV et al (2022) Flow augmentation STA-MCA bypass evaluation for patients with acute stroke and unilateral large vessel occlusion: a proposal for an urgent bypass flowchart [published online ahead of print. J Neurosurg 1–9. https://doi.org/10.3171/2021.10.JNS21986

  15. Thongphetsavong Gautam A, Seh H, Jain A et al (2021) Open microvascular thrombectomy for acute intracranial large vessel occlusion: microsurgery in the endovascular thrombectomy era. World Neurosurg 145:e278–e290

    Article  PubMed  Google Scholar 

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Funding

Jiri Dostal, Jan Mracek, and Vladimir Priban were supported by the Ministry of Health of the Czech Republic — conceptual development of research organization Faculty Hospital in Pilsen; Grant number: FNPl, 00669806.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic

    Jiri Dostal, Jan Mracek & Vladimir Priban

  2. Department of Imaging Methods, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic

    Filip Heidenreich

Authors
  1. Jiri Dostal
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  2. Jan Mracek
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  3. Filip Heidenreich
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  4. Vladimir Priban
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Contributions

Jiri Dostal — conceptualization, case management, surgery, resources, writing original draft, visualization. Jan Mracek — case management, resources, writing – review and editing, funding acquisition. Filip Heidenreich — writing – review and editing, visualization – providing of graphic studies. Vladimir Priban — case management, supervision, resources, writing — review and editing, funding acquisition.

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Correspondence to Jiri Dostal.

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Dostal, J., Mracek, J., Heidenreich, F. et al. Delayed microsurgical revascularization in an acute ischemic stroke based on perfusion study. Acta Neurochir 165, 3825–3830 (2023). https://doi.org/10.1007/s00701-023-05860-8

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  • DOI: https://doi.org/10.1007/s00701-023-05860-8

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