Superficial-Temporal-Artery-To-Middle-Cerebral-Artery Bypass in Cerebrovascular Occlusive Disease and Hemodynamic-Related Ischemia: Illustrative Case and Literature Review

Stroke is the third most common cause of death worldwide. About 10% to 15% of strokes related to the territory of the carotid artery are associated with its complete occlusion. There is an important subgroup of patients with cerebrovascular occlusive diseases who might benefit from an external-carotid-to-internal-carotid bypass. In the present study, we report a case of a 53-year-old male patient with stenosis of the M2 branch of themiddle cerebral artery (MCA), with a history of 20 episodes of transient ischemic accidents (TIA)s, in whom an anastomosis of the M4 branch of the superficial temporal artery-MCA was performed. The patient was discharged in three days, and in the two years of follow-up, they were no more TIAs.We also conducted a review of the literature on cerebrovascular occlusive disease and extracranial-intracranial bypass surgery. New methods to evaluate cerebral hemodynamics made it possible to classify a new subgroup of patients with symptomatic cerebrovascular disease and documented cerebrovascular compromise in whom the drug therapy fails, who can benefit from the extracranial-intracranial bypass. Our case report illustrates the advantages of revascularization in these selected patients.

The influence of blood pressure management on neurological outcome in endovascular therapy for acute ischaemic stroke.

BACKGROUND: Observational studies have suggested that low blood pressure and blood pressure variability may partially explain adverse neurological outcome after endovascular therapy with general anaesthesia (GA) for acute ischaemic stroke. The aim of this study was to further examine whether blood pressure related parameters during endovascular therapy are associated with neurological outcome. METHODS: The GOLIATH trial randomised 128 patients to either GA or conscious sedation for endovascular therapy in acute ischaemic stroke. The primary outcome was 90 day modified Rankin Score. The haemodynamic protocol aimed at keeping the systolic blood pressure >140 mm Hg and mean blood pressure >70 mm Hg during the procedure. Blood pressure related parameters of interest included 20% reduction in mean blood pressure; mean blood pressure <70 mm Hg, <80 mm Hg, and <90 mm Hg, respectively; time with systolic blood pressure <140 mm Hg; procedural minimum and maximum mean and systolic blood pressure; mean blood pressure at the time of groin puncture; postreperfusion mean blood pressure; blood pressure variability; and use of vasopressors. Sensitivity analyses were performed in the subgroup of reperfused patients. RESULTS: Procedural average mean and systolic blood pressures were higher in the conscious sedation group (P<0.001). The number of patients with mean blood pressure <70-90 mm Hg and systolic blood pressure <140 mm Hg, blood pressure variability, and use of vasopressors were all higher in the GA group (P<0.001). There was no statistically significant association between any of the examined blood pressure related parameters and the modified Rankin Score in the overall patient population, and in the subgroup of patients with full reperfusion. CONCLUSION: We found no statistically significant association between blood pressure related parameters during endovascular therapy and neurological outcome. CLINICAL TRIAL REGISTRATION: NCT 02317237.

Long-term social outcome in children with moyamoya disease who have reached adulthood.

OBJECT: Although the reported surgical outcome is favorable, there is little information regarding the long-term quality of life in pediatric patients with moyamoya disease (MMD) when they grow to adulthood. The authors conducted a survey to provide details of social adaptation and satisfaction in adults who underwent revascularization surgery for MMD during childhood. METHODS: One hundred twenty-three patients with MMD who had undergone surgery during childhood and were older than 18 years of age were recruited for this study. The authors mailed self-administered questionnaires regarding each patient's education, employment, marriage, driver's license, physical condition, and satisfaction. Sixty-five patients (53%) responded. RESULTS: Compared with the general population, the patients showed a similar rate of attaining a higher education. Forty-nine (80%) of 61 patients who were not currently high school students had entered college or university. However, the presence of neurological deficits on preoperative examination was a negative predictor of entrance into a college or university, as well as employment. Some patients had difficulty in planning marriage because of physical handicaps, and the rate of acquiring a driver's license and actual driving were relatively low. Approximately 80% of the responders were satisfied with their treatment outcomes, but more than one-half reported subjectively assessed neurological problems. CONCLUSIONS: In this study, pediatric patients with MMD showed favorable social adaptation in adulthood. The findings also indicated that early diagnosis and intervention before the establishment of neurological deficits are essential to children with MMD in becoming better socially adapted. Further, more thorough clinical examinations are required during follow-up in patients with MMD.

Revascularización de las secuelas cerebrovasculares de tipo oclusivo con el epiplón / Revascularization of the cerebrovascular secuela of the oclusive type with the epiplon

Presentamos 25 pacientes con secuelas de enfermedad cerebro vascular de tipo oclusivo que recibieron transplante de epiplón al encéfalo. En el área de lesión se encontraron arterias con flujo sanguíneo residual centrípeta al área de infarto. La mejoría neurológica ocurrió dentro de los primeros días o semanas de la operación. Creemos que estos resultados son debidos a la revascularización y a la influencia de factores neurotróficos proporcionados por el omentum, que actuan sobre el tejido nervioso residual.

[Cerebral hemodynamics according to the results of REG when using sinusoidally modulated currents in accordance with the electrosleep method during the early recovery period after surgery on intracranial arteries]. / Tserebral'naia gemodinamika po dannym REG pri primenenii sinusoidal'nykh modulirovannykh tokov po metodu élektrosna v rannem vosstanovitel'nom periode posle operatsii na vnutricherepnykh arteriiakh.

On the basis of clinical observations and REG recorded in 50 patients in the early restorative period after operations on intracranial cerebral arteries the author recommends a new effective and pathogenetically substantiated method of treatment--sinusoidal modulated currents (SMC) after the method of electric sleep. SMC promotes regression of the focal neurological symptomatology and increases the intensity of cerebral blood flow, evidence of which is the positive time course of REG values.

[Clinico-psychological study of the functions of attention and memory in patients in the early recovery period after reconstructive surgery on the cerebral vessels and their dynamics during treatment with oxygen baths]. / Kliniko-psikhologicheskoe issledovanie funktsii vnimaniia i pamiati u bol'nykh v rannem vosstanovitel'nom periode posle rekonstruktivnykh operatsii na sosudakh golovnogo mozga i ikh dinamika pod vliianiem lecheniia kislorodnymi vannami.

Using psychological methods memory and attention were examined in a control group (normal subjects) and in patients at the early rehabilitation period following reconstructive surgery on cerebral vessels before and after therapy with oxygen baths. The psychological methods of examination were found to be valuable in terms of both diagnosis and assessment of the time-course of the studied parameters at various stages of the treatment. The use of oxygen baths was shown to be effective in disorders of memory and attention.