J Neurol Surg A Cent Eur Neurosurg 2014; 75 - p20
DOI: 10.1055/s-0034-1383756

Emergency Neurosurgical Bypass Revascularization for Acute Ischemic Stroke and Ruptured Complex Aneurysms

J. K. Burkhardt 1, J. Fierstra 1, G. Esposito 1, A. Luft 2, O. Bozinov 1, L. Regli 1
  • 1Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
  • 2Department of Neurology, University Hospital Zurich, Zurich, Switzerland

Aim: 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.