The Clinical Outcome of Emergency Superficial Temporal Artery-to-Middle Cerebral Artery Bypass in Acute Ischemic Stroke with Large Vessel Occlusion: A cohort study and meta-analysis

Objective: We conducted a cohort study to evaluate the clinical outcome of emergency STA-MCA in AIS-LVO and a meta-analysis to assess the clinical outcome of STA-MCA performed to treat early AIS. Methods We recruited newly diagnosed patients with AIS-LVO from January 2019 to March 2022. The patient population was divided into the following two groups: the STA-MCA group and the non-STA-MCA group. Neurological status and outcomes were respectively assessed with the National Institutes of Health Stroke Scale (NIHSS) in the acute phase and the modified Rankin Scale (mRS) during the follow-up. Besides, a meta-analysis of all reported clinical studies was conducted to evaluate the effect of STA-MCA in patients with AIS. Results Our cohort study included 56 patients. The improvement in neurological status was more evident in the STA-MCA group than in the non-STA-MCA group at two weeks after onset (p = 0.030). Multivariable logistic regression analysis indicated that the NIHSS score at two weeks after onset (OR: 0.840; 95% CI: 0.754–0.936, p = 0.002) was the most important factor contributing to a good outcome. In the meta-analysis, the pooled rate (n = 7) for achieving a good outcome (mRS < 3) was 67% (95% CI: 57% − 77%, I 2  = 44.1%) at follow-up points. Conclusions The meta-analysis revealed that STA-MCA for patients with mild to moderate AIS can be judged effective. However, our cohort study suggested that STA-MCA bypass does not seem to improve the prognosis of patients who suffer from AIS-LVO.