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Original Article   

Journal of Neurosurgical Sciences 2022 Mar 17

DOI: 10.23736/S0390-5616.21.05564-8


language: English

Effect of extracranial-intracranial bypass revascularization procedure in acute stroke after endovascular failure: the EIRASP study protocol

Alessia FRATIANNI 1, Giacomo BERTOLINI 1, 2 , Roberto MENOZZI 3, Davide CERASTI 4, Silvia LANA 4, Francesca BOZZETTI 4, Matteo FANTONI 3, Patrizia CECCARELLI 5, Paola CASTELLINI 6, Sandra ROSSI 5, Umberto SCODITTI 6, Ermanno GIOMBELLI 1

1 Department of Neurosurgery, Azienda Ospedaliero-Universitaria, Parma, Italy; 2 Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; 3 Interventional Neuroradiology Unit, Azienda Ospedaliero-Universitaria, Parma, Italy; 4 Neuroradiology Unit, Department of Diagnostic, University Hospital of Parma, Parma, Italy; 5 Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; 6 Stroke Unit, Neuroscience Department (U.S.), University of Parma, Parma, Italy


BACKGROUND: Intravenous thrombolysis and endovascular reperfusion represent nowadays the standard treatment for acute ischemic stroke. However, ineffective reperfusion may occur, representing a major negative prognostic factor on clinical outcome. Extracranial-intracranial (EC-IC) bypass revascularization procedure in an acute setting appears as a promising tool in order to increase reperfusion rates and improve clinical outcome in a highly selected population refractory or ineligible for standard reperfusion therapies.
METHODS: The Extracranial-Intracranial Revascularization for Acute Stroke - Parma (EIRASP) study is an observational, prospective, single-centre, study (protocol 203/2020/OSS/AOUPR). Patients admitted for an acute ischemic anterior circulation stroke due to large vessels occlusion and refractory or ineligible for standard reperfusion therapies will be submitted to an extracranialintracranial bypass revascularization procedure when fulfilling all clinical and radiological inclusion criteria. The primary outcome will be the functional outcome (modified Rankin Scale and NIHSS score) at 3 months after the surgical procedure. Secondary outcome will include the evaluation of clinical and surgical complications rates, quantitative monitoring of perfusion parameters, and further functional and survival rates.
RESULTS: Despite promising data regarding the feasibility and the favourable outcome of urgent EC-IC bypass revascularization procedure in selected patients suffering an acute ischemic stroke are emerging in literature, no studies to date have prospectively explored the real potential of this technique.
CONCLUSIONS: The EIRASP study aims to provide further and stronger methodological evidence of the benefit of urgent EC-IC bypass revascularization procedure in acute ischemic stroke.

KEY WORDS: Cerebral revascularization; Extracranial-intracranial arterial bypass; Ischemic stroke; Perfusion imaging

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