Background
Cerebral bypass surgery is appear to be beneficial in patients with hemodynamic deterioration from intracranial athero-oclusive disease or failed endovascular treatment.
Method
We retrospectively reviewed the clinical and radiological data of 57 consecutive patients treated by both urgent bypass surgery (31 cases, 54.4%) and elective bypass surgery (26 cases, 45.6%) due to large artery occlusion at a single center. The effect of surgical therapy was measured with the modified Rankin scale (mRS) at 3 months. Clinical severity was evaluated by the National Institutes of Health Stroke Scale (NIHSS) at preoperative, postoperative. Major perioperative complications were defined as any hemorrhagic stroke, myocardial infarction, death.
Results
Urgent bypass surgery improved NIHSS after procedures (preoperatively, 9 [4-16]; 2 weeks postoperatively, 6 [2-11]), and major perioperative complications were not significant different in both groups(hemorrhagic stroke 1(3.2%), myocardial infarction 2(6.5%), death 0% in urgent group; hemorrhagic stroke 4(15.4%), myocardial infarction 0%, death 0% in elective group). Favorable (mRS≤3) and good (mRS≤2) outcomes were achieved in 23 (74.2%) and 16 (51.6 %) in urgent group, respectively.
Conclusions
Urgent bypass surgery may be safe and effective alternative treatment for acute ischemic stroke patients with hemodynamic deterioration refractory to maximal medical treatments. Larger randomized clinical study is needed to evaluate the effect of emergency revascularization surgery in acute hemodynamic deterioration.

Emergency STA-MCA bypass surgery in acute ischemic stroke patients with large artery occlusion and hemodynamic deterioration