In:
PLOS ONE, Public Library of Science (PLoS), Vol. 18, No. 5 ( 2023-5-19), p. e0285982-
Abstract:
Despite advances in the nonsurgical management of cerebrovascular atherosclerotic steno-occlusive disease, approximately 15–20% of patients remain at high risk for recurrent ischemia. The benefit of revascularization with flow augmentation bypass has been demonstrated in studies of Moyamoya vasculopathy. Unfortunately, there are mixed results for the use of flow augmentation in atherosclerotic cerebrovascular disease. We conducted a study to examine the efficacy and long term outcomes of superficial temporal artery to middle cerebral artery (STA-MCA) bypass in patients with recurrent ischemia despite optimal medical management. Methods A single-institution retrospective review of patients receiving flow augmentation bypass from 2013–2021 was conducted. Patients with non-Moyamoya vaso-occlusive disease (VOD) who had continued ischemic symptoms or strokes despite best medical management were included. The primary outcome was time to post-operative stroke. Time from cerebrovascular accident to surgery, complications, imaging results, and modified Rankin Scale (mRS) scores were aggregated. Results Twenty patients met inclusion criteria. The median time from cerebrovascular accident to surgery was 87 (28–105.0) days. Only one patient (5%) had a stroke at 66 days post-op. One (5%) patient had a post-operative scalp infection, while 3 (15%) developed post-operative seizures. All 20 (100%) bypasses remained patent at follow-up. The median mRS score at follow up was significantly improved from presentation from 2.5 (1–3) to 1 (0–2), P = .013. Conclusions For patients with high-risk non-Moyamoya VOD who have failed optimal medical therapy, contemporary approaches to flow augmentation with STA-MCA bypass may prevent future ischemic events with a low complication rate.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0285982
DOI:
10.1371/journal.pone.0285982.g001
DOI:
10.1371/journal.pone.0285982.t001
DOI:
10.1371/journal.pone.0285982.t002
DOI:
10.1371/journal.pone.0285982.t003
DOI:
10.1371/journal.pone.0285982.t004
DOI:
10.1371/journal.pone.0285982.t005
DOI:
10.1371/journal.pone.0285982.t006
DOI:
10.1371/journal.pone.0285982.s001
DOI:
10.1371/journal.pone.0285982.s002
DOI:
10.1371/journal.pone.0285982.r001
DOI:
10.1371/journal.pone.0285982.r002
DOI:
10.1371/journal.pone.0285982.r003
DOI:
10.1371/journal.pone.0285982.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2023
detail.hit.zdb_id:
2267670-3
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