"Emergency Cerebral Vascular Anastomosis Surgery Effective for Acute Cerebral Infarction Treatment"

Research Team of Professors Bang Jae-Seung and Lee Si-Woon at Bundang Seoul National University Hospital

Professor Bang Jae-seung (left) and Professor Lee Si-woon, Department of Neurosurgery, Bundang Seoul National University Hospital.

[Asia Economy Reporter Lee Gwan-joo] A research team led by Professors Bang Jae-seung and Lee Si-woon from the Department of Neurosurgery at Bundang Seoul National University Hospital announced on the 12th the results proving the effectiveness of emergency cerebral revascularization surgery for acute cerebral infarction patients for whom endovascular thrombectomy is impossible.

Acute cerebral infarction is a condition in which a cerebral blood vessel suddenly becomes blocked, reducing blood flow and causing brain tissue necrosis. Symptoms suddenly appear, such as speech impairment and weakness in one limb, without prior warning signs. Delayed treatment can result in significant sequelae. Therefore, the treatment goal for acute cerebral infarction is to promptly reopen the blocked cerebral blood vessels to preserve the function of the brain tissue currently undergoing damage as much as possible.

According to recent guidelines, the principle for treating acute cerebral infarction is to perform endovascular thrombectomy within the golden time (a procedure in which a thin catheter is inserted through the femoral artery to directly remove the thrombus inside the cerebral blood vessels). However, if the golden time has passed or thrombectomy is difficult due to the location or shape of the blocked vessel, or if thrombectomy was attempted but failed, there has been no suitable treatment other than administering antiplatelet drugs to inhibit thrombus formation.

The research team suggested that in such situations, ‘cerebral revascularization surgery’ could be a good alternative treatment for acute cerebral infarction. Cerebral revascularization surgery connects external and internal cerebral blood vessels to increase cerebral blood flow and has mainly been performed preventively for patients at high risk of cerebral infarction, such as those with Moyamoya disease. Although there have been reports that cerebral revascularization surgery helps treat acute cerebral infarction, its effectiveness and safety had not been clarified, making it difficult to perform except in some advanced hospitals.

The research team selected 41 patients who underwent emergency cerebral revascularization surgery for acute cerebral infarction between 2006 and 2020, considering whether brain perfusion CT was performed before and after surgery and whether long-term clinical observation was available. They quantitatively analyzed brain perfusion CT images before surgery, immediately after, and six months later to verify the effectiveness of emergency cerebral revascularization surgery. The analysis showed that the volume of areas with blood flow delays of 10, 8, 6, and 4 seconds or more compared to normal decreased over time, indicating that brain perfusion improved in most patients. In particular, the median volume of areas with perfusion delays of 6 seconds or more?a predictor of cerebral infarction recurrence?decreased from 78 mL before surgery to 23 mL immediately after surgery and 5 mL six months post-surgery.

Side effects were also minimal. Comparing the modified Rankin Scale (mRS) scores, an indicator of disability prognosis, before emergency cerebral revascularization surgery and at the last follow-up (approximately 11.7 months post-surgery), the proportion of patients with good prognosis scores of 2 or less increased by 42.9 percentage points, significantly reducing the likelihood of long-term neurological disability. The research team explained that this study is meaningful in that it demonstrated the clinical effectiveness of emergency cerebral revascularization surgery for acute cerebral infarction through imaging evidence, which had not been clearly established before.

Professor Bang Jae-seung stated, “Previously, only supportive treatments to prevent further deterioration were possible for acute cerebral infarction patients for whom endovascular thrombectomy was impossible,” adding, “For patients strictly selected by criteria, emergency cerebral revascularization surgery could offer another chance.” Professor Lee Si-woon emphasized, “If symptoms such as weakness in one limb or slurred speech occur, one should immediately go to the emergency room,” and added, “Since cerebral infarction is closely related to vascular health, it is important to always pay attention to lifestyle improvements such as blood pressure control and smoking cessation.”

This paper was published in ‘Nature Scientific Reports,’ a sister journal of the world-renowned scientific journal Nature.

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