Postoperative watershed shift induced ischemic stroke after direct revascularization surgery in chronic intracranial atherosclerotic steno-occlusive diseases; case series and literature review
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".