Intracranial PTAstenting ECIC Bypass STAMCA bypass Graft to

顱內缺血性腦梗塞- Intracranial PTA/stenting

EC-IC Bypass • STA-MCA bypass • Graft to ICA bypass • OA-PICA bypass • PICA-PICA bypass

Indication for bypass surgery • • • Moyamoya disease: a narrowing of the internal carotid arteries at the base of the brain that can cause multiple strokes or hemorrhages. To compensate for the narrowing arteries, the brain creates collateral blood vessels in an attempt to deliver oxygen-rich blood to deprived areas of the brain. A bypass can restore blood flow to the brain and prevent future strokes. Aneurysm: a bulge or ballooning of an artery wall. Some giant, fusiform, or dissecting aneurysms cannot be treated with surgical clipping or endovascular coiling. In such cases, the parent artery must be sacrificed and the blood flow bypassed for the aneurysm to be effectively treated. Skull base tumor: a tumor can grow where the major vessels enter the skull and surround or invade the artery. Removing the tumor may require sacrificing the encased artery and bypassing the blood flow. Carotid artery stenosis or occlusion: a narrowing or blockage of the carotid artery in the neck caused by atherosclerotic plaque deposits in the vessel wall. Intracranial arterial stenosis: a narrowing or blockage of an artery inside the skull that supplies blood to specific areas within the brain

Case #1 60 Y/O female, progressive aphasia, right limbs weakness Intracranial PTA for MCA stenosis Pre-PTA Post-PTA

Case #2 60 Y/O female, repetitive syncope Intracranial stenting for BA stenosis Pre-stenting Post-stenting

Case #1 72 Y/O male, progressive drowsiness CTA: Thrombus in basilar artery tip R L

IA thrombolysis – Aggressive mechanical clot disruption+UK 75000 U Pre-IA During-IA Post-IA

動脈血栓溶解劑治療: (1999) • PROACT II : Prolyse in Acute Cerebral Thromboembolism II • Results: Modified Rankin score 0 -2 at 90 days: treatment 40%, control 25% (p=0. 04). Recanalization rate: treatment （ 動脈溶栓注射成功開通率）66% (most partial recanalization), control （對照組）18% (p<. 001). ICH with neurological deterioration within 24 hours occurred in （出血併發症）10. 9% of r-pro-UK group and 3. 1% of control group (p=. 06). Overall mortality not different: r-pro. UK 25%, control 27%

Acute ischemic stroke

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