Changes to Inclusion Criteria and Treatment Outcomes of STA-MCA Bypass during the Acute Stage of Progressive Stroke

Few studies have reported superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for management of the acute stage of progressive stroke, and surgical indications remain unclear. We previously reported that STA-MCA bypass performed by experienced and skilled neurosurgeons was associated with favorable outcomes in carefully selected patients. Currently, we use the following patient-selection criteria for this surgery: atherothrombotic cerebral infarction, cerebral ischemia with brain blood flow ＜ 70% of that on the unaffected side, progressive symptoms despite optimal medical treatment or (previously “and”) spread of subcortical cerebral infarction, and interval of ＜ 72 hours from symptom onset. We describe treatment outcomes based on these criteria.We compared 31 and 59 patients who underwent STA-MCA bypass during the acute stage of stroke between 2014 and 2018 and between 2002 and 2013, respectively at our hospital. The rate at which independent walking ability was achieved improved from 59.3% to 77.4%. However, the National Institutes of Health Stroke Scale scores did not significantly differ at the time of discharge. Acute-stage bypass procedures are increasingly being performed in clinical practice, and further accumulation of evidence is expected. In our view, larger numbers of patients are receiving treatment owing to expansion of indications for this operation based on closely examined policies.