Superficial temporal artery - Middle cerebral artery anastomosis for acute cerebral ischemia: The effect of small augmentation of blood flow

In order to evaluate the effectiveness of acute cerebral revascularisation, we conducted a review of 70 patients with acute arterial occlusion or severe stenosis. Of these, 35 underwent emergency superficial temporal artery - middle cerebral artery (STA-MCA) anastomosis (surgical group) and the other 35 were treated conservatively (non-surgical group) at different times. Statistical analysis indicated that the two groups were homogeneous for the prognostic indicators. Seven days after admission, neurological symptoms and signs improved in 43% of patients in the surgical group and in 29% of the non-surgical group, however, this difference was not significant. The ratios of independent life at 3 months were 51% and 31%, respectively (not significant). Subgroup analyses indicated that final outcomes for patients with mild to moderate paresis on admission were significantly better in the surgical group than in the nonsurgical group (94% vs. 53%, p < 0.01). The ratios of haemorrhagic infarction, neurological worsening, and mortality were comparable between the two groups. Time of ischaemia is a less important factor in the criteria for surgical selection. Acute revascularisation in selected patients does improve a natural course and could be a therapeutic option for acute cerebral ischaemia.