Quantitative radiological analysis and clinical outcomes of urgent EC-IC bypass for hemodynamic compromised patients with acute ischemic stroke

• Published in: Scientific reports Vol. 12; no. 1; p. 8816
• Main Authors: Jo, Hyunjun, Seo, Dongwook, Kim, Young Deok, Ban, Seung Pil, Kim, Tackeun, Kwon, O-Ki, Oh, Chang Wan, Sunwoo, Leonard, Kim, Beom Joon, Han, Moon-Ku, Bae, Hee-Joon, Lee, Si Un, Bang, Jae Seung
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 25-05-2022; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308; 692/617; Brain Ischemia - complications; Brain Ischemia - diagnostic imaging; Brain Ischemia - surgery; Cerebral infarction; Clinical outcomes; Computed tomography; Hemodynamics; Humanities and Social Sciences; Humans; Ischemia; Ischemic Stroke - diagnostic imaging; Ischemic Stroke - surgery; multidisciplinary; Neurological complications; Occlusion; Patients; Perfusion; Retrospective Studies; Science; Science (multidisciplinary); Stenosis; Stroke; Stroke - diagnostic imaging; Stroke - etiology; Stroke - surgery
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-12728-x

This study aimed to demonstrate the effectiveness of urgent extracranial-to-intracranial bypass (EIB) in acute ischemic stroke (AIS) through quantitative analysis of computed tomography perfusion (CTP) results using RAPID software. We retrospectively analyzed 41 patients who underwent urgent EIB for AIS under strict operation criteria. The quantitative data from CTP images were reconstructed to analyze changes in pre- and postoperative perfusion status in terms of objective numerical values using RAPID software. Short- and long-term clinical outcomes, including complications and neurological status, were also analyzed. Postoperatively, the volume of time-to-max (Tmax) > 6 s decreased significantly; it continued to improve significantly until 6 months postoperatively (preoperative, 78 ml (median); immediate postoperative, 23 ml; postoperative 6 months, 7 ml;
p
 = 0.000). Ischemic core-penumbra mismatch volumes were also significantly improved until 6 months postoperatively (preoperative, 72 ml (median); immediate postoperative, 23 ml; postoperative 6 months, 5 ml;
p
 = 0.000). In addition, the patients’ neurological condition improved significantly (
p
 < 0.001). Only one patient (2.3%) showed progression of infarction. Urgent EIB using strict indications can be a feasible treatment for IAT-ineligible patients with AIS due to large vessel occlusion or stenosis.