Abstract 74: Improvement in Cerebral Hemodynamic Parameters and Outcome after Superficial Temporal Artery- Middle Cerebral Artery Bypass in Patients with Severe Steno-occlusive Disease of Intracranial Carotid and Middle Cerebral Artery
Background and Objective: Older and the recent extracranial-intracranial (EC/IC) bypass trials for symptomatic carotid occlusion failed to demonstrate reduction in stroke recurrence. However, role of superficial temporal artery-middle cerebral artery (STA-MCA) bypass in patients with symptomatic intracranial steno-occlusive disease has been evaluated scarcely. We evaluated serial changes in various cerebral hemodynamic parameters in patients with severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) and impaired cerebral vasodilatory reserve (CVR), treated with STA-MCA bypass surgery or medical treatment.
Methods: Patients with severe steno-occlusive disease of intracranial ICA or MCA underwent transcranial Doppler (TCD) ultrasonography and CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-challenged hexamethylpropyleneamine-oxime single-photon emission computed tomography (HMPAO-SPECT). STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. All patients underwent TCD and SPECT at 4±1 months and followed-up for cerebral ischemic events.
Results: A total of 112patients (73males, mean age 56yrs; range 23-78yrs) were included. HMPAO-SPECT demonstrated impaired CVR in 77 (69%) patients. Of them, 46 underwent STA-MCA bypass while 31 received best medical treatment. TCD and acetazolamide-challenged HMPAO-SPECT repeated 4±1months showed significant improvement in STA-MCA bypass group. During follow-up (mean 34months; range 18-39months), only 6/46 (13%) patients in bypass group developed cerebral ischemic events as compared to 14/31 (45%) cases on medical therapy (absolute risk-reduction 32%, p=0.008).
Conclusion: STA-MCA bypass surgery in carefully selected patients with symptomatic severe intracranial steno-occlusive disease results in significant improvement in hemodynamic parameters and reduction in stroke recurrence.
Author Disclosures: L. Yeo: Research Grant; Significant; NMRC. P. Paliwas: None. A. Ahmad: None. A.K. Sindha: None. H. Teoh: None. L.Y. Wong: None. V.F. Chong: None. R.C. Seet: None. B.P. Chan: None. T. Yeo: None. N. Chou: None. V.K. Sharma: None.
- © 2015 by American Heart Association, Inc.