Staged revascularization for main cerebral arterial occlusion using intravascular procedures and surgery

Abstract

We report on 4 cases of acute cerebrovascular ischemia treated with staged revascularization. Fibrinolytic therapy for acute cerebral ischemia is often not sufficient to improve the hemodynamic status, and in these patients prevention of ischemia recurrence and achievement of stable hemodynamics are necessary. We used intravascular techniques, consisting of intraarterial infusion of urokinase or percutaneous transluminal angioplasty as the first procedure, in 4 such patients. Carotid endarterectomy or superficial temporal artery middle cerebral artery (STA-MCA) anastomosis was subsequently performed as the second procedure. All 4 acute stage, critical patients recovered hemodynamic stability and their symptoms were ameliorated. We suggest that staged revascularization is an useful treatment modality in selected patients with acute cerebral ischemia and impaired hemodynamic status.