Journal of Neurosurgical Sciences 2020 Dec 09

DOI: 10.23736/S0390-5616.20.05110-3

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Flow-augmentation bypass in the treatment of acute ischemic stroke

Lelio GUIDA ^{1, 2}, Martina SEBÖK ¹, Susanne WEGENER ³, Jorn FIERSTRA ¹, Bas VAN NIFTRIK ¹, Andreas R. LUFT ^{3, 4}, Luca REGLI ¹, Giuseppe ESPOSITO ¹ ✉

¹ Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Centre, Zurich, Switzerland; ² Department of Neurosurgery, University of Milan, Milan, Italy; ³ Department of Neurology, University Hospital Zurich, Clinical Neuroscience Centre, Zurich, Switzerland; ⁴ Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland

INTRODUCTION: Results of 2 randomized trials did not show benefit of revascularization with extracranial-intracranial (EC-IC) flow augmentation bypass in patients with symptomatic occlusion of internal carotid artery (ICA). However, patients with acute stroke were not included in these studies. Herein, we systematically analyze and discuss the literature about flow augmentation bypass for treatment of acute ischemic stroke.
EVIDENCE ACQUISITION: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. MEDLINE, Web of Science and EMBASE were independently searched by two reviewers for published series to identify literature relating to EC-IC bypass in the surgical management of acute ischemic stroke up to June 2020. Studies were categorized according to their level of evidence.
EVIDENCE SYNTHESIS: Nineteen studies met the inclusion criteria for the systematic literature review, including 16 level IV studies (10 case-series and 6 case reports) and 3 level III studies (retrospective cohort case-control studies). Occurrence of fatal or non-fatal ischemic or hemorrhagic postoperative stroke, as well as clinical functional outcome at follow-up were
considered as primary and secondary endpoints, respectively.
CONCLUSIONS: The literature about flow augmentation bypass for treatment of acute ischemic stroke is scarce and heterogenous, with only 19 studies. The results of the present systematic review encourage further study to explore and validate the use of EC-IC bypass in the treatment of anterior circulation acute ischemic stroke in highly selected patients (symptomatic and with persistent penumbra despite best medical/endovascular treatment).

KEY WORDS: Acute ischemic stroke; direct revascularization; EC-IC Bpass; Flow augmentation bypass; STA-MCA bypass