A BSTRACT Ischaemic stroke can arise from the stenosis and occlusion of a carotid artery by a clot (embolic) or local thrombosis. Haemodynamic stroke is one of the types of ischaemic stroke that occurs due to discrepancy between demand and supply of cerebral blood flow because of cerebral arterial occlusion or high-grade stenosis but can also arise with systemic conditions reducing blood pressure. Treatment of haemodynamic stroke focuses on increasing blood flow to the affected brain region by best medical therapy (BMT) and managing blood pressure (potentially keeping it slightly higher than normal) and may include considering procedures like extra-intracranial flow augmentation bypass surgery (revascularisation surgery) in specific cases when necessary to improve perfusion. Traditionally, revascularisation surgery has been used in the treatment of skull base tumours requiring sacrifice of a large intracranial artery; complex intracranial aneurysms requiring trapping; and distal revascularisation and moyamoya disease. Current evidence does not support routine use of revascularisation in symptomatic cerebrovascular steno-occlusive disease but suggests that carefully selected patients with refractory haemodynamic symptoms may still be candidates. This review summarises the current historical background and knowledge regarding challenges in the field of haemodynamic stroke and their management, putting forward a clinical and research strategy on the effects of revascularisation in terms of cerebral haemodynamic change, cognition and quality of life of patients in the case of symptomatic cerebral atherosclerotic stenosis and occlusion. This review will also help readers understand the importance of revascularisation in this type of ischaemic stroke.
Verma et al. (Sat,) studied this question.