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  • Emergency neurosurgical bypass revascularization for acute ischemic stroke and ruptured complex aneurysms

    Final Number:

    Oliver Bozinov MD; Jan-Karl Burkhardt MD; Jorn Fierstra drs.; Andreas Luft; Luca Regli

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: To evaluate the safety and patient outcome of individualized bypass revascularization strategies applied in the emergency setting for the treatment of acute ischemic stroke (AIS) and ruptured complex aneurysm (rCA) in combination with aneurysm trapping.

    Methods: We reviewed 11 consecutive patients (5 with AIS and 6 with rCA) undergoing emergency surgery with either low-flow EC-IC (n=7), low-flow side-to-side IC-IC (n=2), or high-flow excimer laser assisted non-occlusive anastomosis (ELANA) EC-IC (n=2) bypasses. Clinical status as well as neuroimaging examinations were evaluated pre- and postoperatively.

    Results: The emergency bypass revascularization was performed with a mean time of 2.5 days (SD 1.1, range 1-4) after admission. There were no surgical complications such as anastomosis failure (early patency 11/11), postoperative hemorrhage or hyperperfusion syndrome. After emergency bypass all patients were discharged in good clinical condition with an improved mean NIHSS of 3.8 points (up to mean of 2.6) and regaining independence in all-day activities with an improved median mRS of 1 point (up to median of 2).

    Conclusions: Microsurgical revascularization can be safely performed as one option in an emergency setting with good clinical outcome in patients with acute ischemic stroke or ruptured complex aneurysms.

    Patient Care: Another option in acute stroke should be considered.

    Learning Objectives: To evaluate the ec-ic bypass option after special kinds of strokes.


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