中大脳動脈閉塞による亜急性期progressing strokeに対する緊急STA-MCA bypass術  [in Japanese] Efficacy of Emergency STA-MCA Anastomosis for Middle Cerebral Artery Occlusion in Patients with Progressing Stroke  [in Japanese]

We report 4 cases with progressing stroke due to middle cerebral artery (MCA) occlusion, who were successfully treated by emergency superficial temporal artery (STA)-MCA anastomosis during the subacute stage. Surgical STA-MCA anastomosis is indicated by JET study to prevent the recurrence of severe ischemia. However, an indication for STA-MCA anastomosis to treat acute ischemic stroke due to main trunk artery occlusion is not established because of conflicting opinions regarding issues such as reperfusion injury. Nevertheless, the clinical outcome of occasional STA-MCA anastomosis performed at the subacute stage of progressing stroke is good. Four patients underwent emergency STA-MCA double anastomoses at our hospital between 1998 and 2005 to treat progressing stroke. All patients were males aged 40-69 years (median, 51.8 years). The cause was low perfusion ischemia due to MCA occlusion caused by atherosclerosis, and a small ischemic lesion was depicted in the corona radiata or motor cortex. The duration from onset to surgery was 2 to 8 days (median, 4.75 days). The initial symptoms were progressive allophasis (n=3) and motor paresis (n=1). All 4 patients underwent emergency STA-MCA anastomoses. All of them slowly achieved obvious remission compared with symptoms on admission and returned to their jobs. We therefore recommend STA-MCA bypass surgery for patients with progressive ischemia due to MCA occlusion even at the subacute stage.