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Medic-All Stroke Center, CMUH 〉 Extra-Intra Cranial Bypass & Intra-arterial Thrombectomy

Extra-Intra Cranial Bypass & Intra-arterial Thrombectomy

Extra-Intra Cranial Bypass & Intra-arterial Thrombectomy

EC-IC bypass, like coronary artery bypass surgery (CABG), connects an extracranial vessel to the brain surface vessel to increase cerebral blood flow and reduce the chance of reoccurrence of stroke.

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Overview
1. EC-IC bypass: Diamox challenge test is conducted before the surgery to obtain CT Angiography and dynamic cerebral blood flow images to help identify the areas with insufficient blood flow in patients with intracranial arterial embolism to provide more precise and safer treatments. We are the only hospital that has this medicine; therefore, the only one that can conduct this unique Diamox challenge test to identify high and medium risk patients to receive surgery to prevent cerebral stroke. EC-IC bypass surgery is also conducted for patients who need difficult intracranial aneurysm surgery to prevent post-surgery cerebral stroke. EC-IC bypass is conducted as well for patients who need difficult brain tumor surgery to prevent post-surgery ischemia and for patients with carotid artery obstruction caused by radiotherapy for craniocervical tumor to reduce the occurrence of post-surgery cerebral stroke.
 
2. IA Thrombectomy utilizes Ductus arteriosus and Penumbra System to directly go into the blockage spot in the intracranial artery to use intravascular stent or suction to remove the blockage directly for better treatment outcomes.
Features
1. EC-IC bypass: increases the treatment opportunity for cerebral stroke patients. EC-IC bypass, like coronary artery bypass surgery (CABG), connects an extracranial vessel to the brain surface vessel to increase cerebral blood flow and reduce the chance of reoccurrence of stroke.

EC-IC bypass can prevent patients with intracranial and extracranial artery blockage from having a stroke again. 641 patients received this surgery during 2007-2015. The post-surgery follow-up for reoccurrence of stroke is reduced to 1.8% (medicine treatment is 22%), which indicates significant treatment outcome.
 
2. The important concept of IA Thrombectomy treatment for acute cerebral vascular accident is “seize the time”. The earlier the artery blockage is removed, the less neurologic damage will be caused. IA Thrombectomy can rescue and treat more cerebral stroke patients.

The statistics indicates that 116 patients received IA Thrombectomy during 2014-2016 with 85.6% of the blockage removed and door to puncture time:122. Outcome analysis showed that patients improved 15 points on neurologic damage scale (NIHSS)  (average on arrival 25 points – discharge 10 points). The 3 months follow-up on daily movement ability (MRS) was 0-2 points, taking up 31.6% (independent for daily basic routine, even returned back to work).
Service Procedure
1.EC-IC by pass:



2.IA Thrombectomy:

Figure 1A: The new “Intra-arterial Penumbra System” is a retrievable stent.
Figure 1B: Once released, the stent can push the blockage aside and the cerebral blood flow will resume. When retrieved, the stent will catch and remove the blockage.
Notification
1. EC-IC bypass: The longer the surgery takes, the higher the risk is for cerebral ischemia. The average surgery time at CMUH is 29 minutes, which shortens the time of cerebral ischemia and reduces the risk of cerebral ischemia during surgery, and results in 0% of post-surgery hemorrhage.

2. IA Thrombectomy: Although Penumbra System brought breakthrough for acute stroke treatment, there is still 10-30% of failure of removing the blockage, within 10% of post-surgery symptomatic cerebral hemorrhage, and 10-20% of post-surgery mortality. Besides, there is 10% of risk of causing strokes in other areas and vascular damages.
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