Effectiveness of cerebral bypass revascularisation procedures in adult cerebrovascular ischaemic stroke: Looking beyond COSS – A single surgeon's experience of 7 years

Context: Adults with haemodynamic stroke secondary to cerebrovascular ischaemic events, continue to develop stroke despite optimum medical management. Aims: This study aims to identify patients with adult ischaemic stroke presenting with significant haemodynamic failure based on radiological and molecular imaging and perform Revascularisation procedure to prevent further stroke. Settings and Design: This is a retrospective database analysis of patients with CVOD requiring cerebral revasularisation procedure from 2013 to 2019. Materials and Methods: Twenty-two adult patients with age ranging from 26 to 72 years presenting with recurrent transient ischaemic attacks (TIAs) were evaluated for haemodynamic insufficiency by neuroimaging and acetazolamide challenged single-photon emission computed tomography perfusion. Those with decompensated haemodynamic insufficiency underwent cerebral revascularisation with superficial temporal artery (STA) to middle cerebral artery (MCA) bypass. Results: Of the 22 patients, in 12 patients, the procedure was done electively and in remaining 10 patients as emergency (<48 h of the onset of symptoms). Ninety-one per cent of the patients recovered well without any further TIAs. Neurological worsening was observed in 4.5%. Two patients who presented with refractory migraine like symptoms improved dramatically without further headaches. Uneventful wound complications were associated in 9% of cases. Follow-up radiological evaluation showed good graft patency in 95% (21/22) patients. The single case of graft thrombosis developed new MCA territory infarct requiring prolonged rehabilitation for the neurological deterioration. Conclusion: Cerebral revascularisation with STA-MCA bypass in selected patients with impending haemodynamic insufficiency results in good outcome and prevents further strokes despite continuing optimum medical therapy.