====== Extracranial-intracranial bypass for ischemic stroke ======


One main indication today is [[stroke]] prevention by flow augmentation in the setting of [[chronic cerebral hemodynamic ischemia]].
----
[[Human immunodeficiency virus]] (HIV)-associated [[vasculopathy]] can cause [[ischemic stroke]]; however, there is limited evidence on optimal [[management]]. 

Mizushima et al. reported a case of [[acute ischemic stroke]] due to progressive [[internal carotid artery stenosis]] in an [[HIV]]-positive patient. [[Superficial temporal artery to middle cerebral artery bypass]]), in addition to the best medical treatments, prevented [[stroke]] progression.

A 39-year-old man with HIV infection presented with a sudden onset of [[aphasia]] and right [[hemiparesis]]. Magnetic resonance imaging revealed an ischemic lesion in the left[[ basal ganglia]] and concentric thickening of the vessel wall in the terminal portion of the bilateral ICAs. Despite maximal medical treatments for HIV-associated vasculopathy and possible opportunistic infections, bilateral ICA stenoses progressed, leading to a second hemodynamic stroke event. Because [[tissue plasminogen activator]] treatment failed, they performed STA-MCA bypass. A significant improvement in neurological symptoms and [[cerebral blood flow]] was observed after surgery. No further stroke events occurred during the continuation of medical treatments
((Mizushima M, Sugiyama T, Eguchi K, Tarisawa M, Tokairin K, Ito M, Hashimoto D, Yabe I, Fujimura M. Rescue [[extracranial-intracranial bypass for ischemic stroke]] secondary to progressive [[human immunodeficiency virus]]-associated [[vasculopathy]]. J Neurol Surg A Cent Eur Neurosurg. 2022 Feb 22. doi: 10.1055/a-1779-4142. Epub ahead of print. PMID: 35193153.)).