Case Report/Case SeriesUrgent Bypass Surgery Following Failed Endovascular Treatment in Acute Symptomatic Stroke Patient With MCA OcclusionLee, Chang Yeob MD*; Kim, Chang Hyun MD†; Lee, Chang-Young MD†; Sohn, Sung-Il MD*; Hong, Jeong-Ho MD, PhD* Author Information Departments of *Neurology †Neurosurgery, Keimyung University Dongsan Medical Center, Daegu, Korea The authors declare no conflict of interest. Reprints: Jeong-Ho Hong, MD, PhD, Department of Neurology, Keimyung University Dong San Medical Center, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea. E-mail: [email protected]. The Neurologist: January 2017 - Volume 22 - Issue 1 - p 14-17 doi: 10.1097/NRL.0000000000000086 Buy Metrics Abstract Introduction: Although the benefits of extracranial-intracranial bypass surgery remain controversial, there is some surgical rationale for the augmentation of cerebral blood flow in cases of acute ischemic stroke with hemodynamic instability. Case Report: We report a case of a 62-year-old woman who suddenly developed right hemiplegia and global aphasia. Initial magnetic resonance imaging and magnetic resonance angiography revealed a small acute ischemic lesion in left parietal lobe with occlusion at the left middle cerebral artery. We performed an endovascular thrombectomy, which failed. Her neurological deficits remained unchanged. On the basis of immediate postendovascular magnetic resonance perfusion, diffusion-weighted imaging (DWI), and neurological examination, an obvious clinical-DWI and a DWI–perfusion-weighted imaging mismatch were detected. We decided to perform emergency superficial temporal artery to middle cerebral artery bypass to prevent further progression of cerebral ischemia. On a 3-month follow-up, neurological deficits remained minimal motor aphasia and dysarthria. Conclusions: Following failed endovascular treatment in patients with acute symptoms attributed to major cerebral artery occlusion, we recommend immediate multimodal neuroimaging. If there are clinical-DWI and DWI–perfusion-weighted imaging mismatch indications, surgical revascularization could be considered as the next salvageable strategy. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.