イシグロ　タイチ   ISHIGURO Taichi   石黒　太一    所属   医学部 医学科（附属八千代医療センター）    職種   准教授
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Postoperative watershed shift induced ischemic stroke after direct revascularization surgery in chronic intracranial atherosclerotic steno-occlusive diseases; case series and literature review.
掲載誌名	正式名：Acta neurochirurgica 略　 称：Acta Neurochir (Wien) ISSNコード：09420940/00016268
掲載区分	国外
巻・号・頁	167(1),pp.315
著者・共著者	Masahiko Nishitani, Taichi Ishiguro, Shunsuke Nomura, Yoshihiro Omura, Kostadin Karagiozov, Tadasuke Tominaga, Nobuhiko Momozaki, Mana Suzuki, Akitsugu Kawashima, Takakazu Kawamata
発行年月	2025/12
概要	BACKGROUND:Extracranial-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.METHODS:We 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.RESULTS:Postoperative 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.CONCLUSIONS:WSIS is a rare (1.9%), but important complication after STA-MCA bypass, occurring in patients who have preserved anterograde flow preoperatively.
DOI	10.1007/s00701-025-06715-0
PMID	41331530