Dr. Moritz Förster (Mönchengladbach / DE), Dr. Marius Lamers (Mönchengladbach / DE), Dr. Götz Greif (Mönchengladbach / DE), Talha Turan (Mönchengladbach / DE), Lena Kohn (Mönchengladbach / DE), PD Dr. Sajjad Muhammad (Düsseldorf / DE), Prof. Dr. med. Kerim Beseoglu (Düsseldorf / DE), Prof. Dr. Adrian Ringelstein (Mönchengladbach / DE), Prof. Dr. Jan Frederick Cornelius (Düsseldorf / DE), Prof. Dr. Philipp Albrecht (Mönchengladbach / DE; Düsseldorf / DE)
Abstract-Text (inkl. Referenzen und Bildunterschriften)
Introduction:
We present a 44-year-old male with carotid artery disease-induced hemiparesis, highlighting the role of extracranial-intracranial (EC-IC) bypass surgery in selected cases and the ongoing efficacy debate.
Case Presentation:
The patient exhibited right-sided hemiparesis with an embolic infarction in the left middle cerebral artery territory. Imaging confirmed left internal carotid artery (ICA) occlusion, right ICA stenosis, and cerebral perfusion abnormalities. Despite conservative management, neurological deficits progressed. The patient developed a two-stage left hemodynamic infarction.
Intervention and Outcome:
Emergency angiography and stent placement in the right ICA improved symptoms temporarily, but recurrent hypotension led to insufficient cerebral perfusion. The neurological condition could only be kept stable through continuous vasopressor therapy. EC-IC bypass surgery successfully restored patient's condition. Vasopressor therapy could be stopped. The causative macroangiopathy was most likely due to chronic nicotine consumption and elevated LDL cholesterol levels.
Discussion:
This case supports EC-IC bypass as an option in carotid artery disease-related hemiparesis, especially with blood pressure-dependent symptoms. Timing and patient selection are critical as is the choice of the executing center, which should have a high level of expertise and performance rate. Conflicting study results necessitate further research (1-3).
Conclusion:
EC-IC bypass surgery demonstrated efficacy in managing acute hemiparesis from carotid artery disease. Careful patient selection and a multidisciplinary approach are crucial for optimal outcomes. Further research is warranted for clearer guidelines.
Ma Y, Wang T, Wang H, Amin-Hanjani S, Tong X, Wang J, et al. Extracranial-Intracranial Bypass and Risk of Stroke and Death in Patients With Symptomatic Artery Occlusion: The CMOSS Randomized Clinical Trial. JAMA. 2023;330(8):704-14. Nguyen VN, Motiwala M, Parikh K, Miller LE, Barats M, Nickele CM, et al. Extracranial-Intracranial (EC-IC) Cerebral Revascularization for Atherosclerotic Vessel Occlusion: An Updated Systematic Review of the Literature. World Neurosurgery. 2023. Jo H, Seo D, Kim YD, Ban SP, Kim T, Kwon O-K, et al. Quantitative radiological analysis and clinical outcomes of urgent EC-IC bypass for hemodynamic compromised patients with acute ischemic stroke. Scientific Reports. 2022;12(1):8816.