Evidence map›Paper›PMID 41331530›Full record

ReviewActa neurochirurgica2025

Postoperative watershed shift induced ischemic stroke after direct revascularization surgery in chronic intracranial atherosclerotic steno-occlusive diseases; case series and literature review.

Masahiko Nishitani, Taichi Ishiguro, Shunsuke Nomura, Yoshihiro Omura, Kostadin Karagiozov, Tadasuke Tominaga, Nobuhiko Momozaki, Mana Suzuki, Akitsugu Kawashima, Takakazu Kawamata

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PubMed Full text at PMC Publisher
In one paragraph

Review in Acta neurochirurgica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Masahiko NishitaniDepartment of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Owadashinden 477-96, Yachiyo-Shi, Chiba, 2768524, Japan.
Taichi IshiguroDepartment of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Owadashinden 477-96, Yachiyo-Shi, Chiba, 2768524, Japan. ishiguro.taichi@twmu.ac.jp.
Shunsuke NomuraKrembil Research Institute, Universtiy of Toronto, Toronto, ON, Canada.
Yoshihiro OmuraDepartment of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Owadashinden 477-96, Yachiyo-Shi, Chiba, 2768524, Japan.
Kostadin KaragiozovDepartment of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Owadashinden 477-96, Yachiyo-Shi, Chiba, 2768524, Japan.
Tadasuke TominagaDepartment of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Owadashinden 477-96, Yachiyo-Shi, Chiba, 2768524, Japan.
Nobuhiko MomozakiDepartment of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Owadashinden 477-96, Yachiyo-Shi, Chiba, 2768524, Japan.
Mana SuzukiDepartment of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Owadashinden 477-96, Yachiyo-Shi, Chiba, 2768524, Japan.
Akitsugu KawashimaDepartment of Neurosurgery, St. Luke's International Hospital, Tokyo, Japan.
Takakazu KawamataDepartment of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundExtracranial-intracranial (EC-IC) bypass surgery is performed to reduce the risk of ipsilateral cerebral infarction in selected patients with chronic intracranial atherosclerotic steno-occlusive disease (ICAD) with reduced cerebral blood flow (CBF). However, postoperative watershed shift induced ischemic stroke (WSIS) may occasionally occur despite maintained bypass patency and improved CBF. We report the incidence and characteristic features of WSIS after superficial temporal artery-middle cerebral artery (STA-MCA) bypass for chronic WSIS.

methodsWe retrospectively analyzed 158 patients with symptomatic chronic ICAD and impaired CBF and cerebrovascular reactivity who underwent STA-MCA bypass between 2013 and 2023. Clinical data and pre- and postoperative imaging findings were analyzed to identify WSIS.

resultsPostoperative bypass patency was 100%. Ischemic complications occurred in 3 of 158 patients (1.9%), all of which were WSIS. Notably, 3 WSIS cases occurred in patients with severe internal carotid artery stenosis. These infarctions occurred on postoperative day 3, despite good bypass patency. Angiography confirmed bypass flow supplied the entire MCA, but anterograde ICA flow was consequently reduced, leading to a hemodynamic shift.

conclusionsWSIS is a rare (1.9%), but important complication after STA-MCA bypass, occurring in patients who have preserved anterograde flow preoperatively.

Indexed as

Cerebral RevascularizationIntracranial ArteriosclerosisIschemic StrokePostoperative ComplicationsAgedAged, 80 and overCarotid StenosisCerebrovascular CirculationChronic DiseaseFemaleHumansMaleMiddle AgedMiddle Cerebral ArteryRetrospective StudiesTemporal ArteriesAtherosclerosisBypassInfarctionMiddle cerebral arterySuperficial temporal artery

Identifiers

PMID41331530
PMCPMC12680796

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.