An Anatomic Mathematical Measurement to Find an Adequate Recipient M4 Branch for Superficial Temporal Artery to Middle Cerebral Artery Bypass Surgery

Kadri, Paulo A S; Krisht, Ali F.; Gandhi, Gautam K.

doi:10.1227/01.neu.0000289716.25921.9a

Cited by 9 publications

(6 citation statements)

References 15 publications

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“…Those vascular structures that eventually carry the flowing arterial blood into the brain parenchyma are, however, not the macrovascular pial M2–M4 segments but a dense network of pial arterioles on the brain surface and the perforating arterioles, both of which mark the transition between the macro- and micro- circulation. The terminal macrovascular MCA segments (M4) typically span a size range of 250–1000 microns [ 19 , 20 ], whereas the network of surface and penetrating arterioles typically ranges in diameter from 40 to 280 microns, according to the work of Duvernoy [ 21 ]. The “penetrating” or “perforating” arterioles branch off from the pial surface network.…”

Section: Hemodynamic Consequences After M1 Occlusionmentioning

confidence: 99%

Facing Time in Ischemic Stroke: An Alternative Hypothesis for Collateral Failure

Pham

Bendszus

2016

Clin Neuroradiol

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Several randomized-controlled trials could recently demonstrate that ischemic stroke which is caused by large-cerebral-artery-occlusion can be treated effectively by endovascular recanalization. Among these studies, particularly the data from the ESCAPE study further corroborated the strong association between macrovascular pial collateral flow (before recanalization) and clinical outcome after recanalization. This review briefly gives an overview on these data and on the clinical key observations demonstrating this association in practice. Since the ischemic penumbra can only be sustained by collateral flow, the collapse of collateral blood flow or poor collateral filling, observed for example by DSA or CTA before recanalization, seems to be a primary cause of rapidly progressive infarction and futile therapeutic recanalization. However, it needs to be emphasized that the true cause-effect relationship between collateral failure and rapidly progressive infarction of the penumbra, i.e. the high probability of unfavorable clinical outcome despite recanalization, remains unclear. Along this line, an alternative hypothesis is offered viewing the collapse of collateral flow not as a cause but possibly as an inevitable secondary consequence of increasing peripheral/microvascular resistance during progressive infarction.

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Section: Hemodynamic Consequences After M1 Occlusionmentioning

confidence: 99%

Facing Time in Ischemic Stroke: An Alternative Hypothesis for Collateral Failure

Pham

Bendszus

2016

Clin Neuroradiol

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“…Almost all large anatomical studies of STA and MCA dimensions have been performed in cadavers or at autopsy, with the inherent inaccuracy that fixatives and the use of latex-injected vessels may cause in the vessels studied (Kadri et al, 2007;Kawashima et al, 2005;Marano et al, 1985;Pinar and Govsa, 2006;Stock et al, 1980;Waddington, 1979). In addition, STA sizes are usually reported at the level of the zygoma or bifurcation and not at the site of potential microanastomosis.…”

Section: Vessel Dimension and Clinical Diseasementioning

confidence: 99%

Intraoperative Blood Flow Analysis of Direct Revascularization Procedures in Patients with Moyamoya Disease

Lee

Guzman

Bell-Stephens

et al. 2010

J Cereb Blood Flow Metab

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Moyamoya disease is characterized by the progressive stenosis and often occlusion of the terminal internal carotid arteries, which leads to ischemic and hemorrhagic injuries. The etiology is unknown and surgical revascularization remains the mainstay treatment. We analyzed various hemodynamic factors in 292 patients with moyamoya disease, representing 496 revascularization procedures, including vessel dimension and intraoperative blood flow, using a perivascular ultrasonic flowprobe. Mean middle cerebral artery (MCA) flow rate was 4.4 ± 0.26 mL/min. After superficial temporal artery (STA)-MCA bypass surgery, flows at the microanastomosis were increased fivefold to a mean of 22.2 ± 0.8 mL/min. The MCA flows were significantly lower in the pediatric (16.2 ± 1.3 mL/min) compared with the adult (23.9 ± 1.0 mL/min; P<0.0001) population. Increased local flow rates were associated with clinical improvement. Permanent postoperative complications were low (<5%), but very high postanastomosis MCA flow was associated with postoperative stroke (31.2 ± 6.8 mL/min; P=0.045), hemorrhage (32.1 ± 10.2 mL/min; P=0.045), and transient neurologic deficits (28.6 ± 5.6 mL/min; P=0.047) compared with controls. Other flow and vessel dimension data are presented to elucidate the hemodynamic changes related to the vasculopathy and subsequent to surgical intervention.

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“…In addition, use of this model can reduce the numbers of live animals used in experiments by 80 - 100% 15). The average size of the cortical branch of the MCA is known to be 1.0 mm (range, 0.6 - 1.4 mm), which is similar to the size of the radial artery of chicken wings 9). The structure of a chicken wing resembles that of a human arm.…”

Section: Discussionmentioning

confidence: 96%

An Efficient Microvascular Anastomosis Training Model Based on Chicken Wings and Simple Instruments

Kim

Jeong

et al. 2013

J Cerebrovasc Endovasc Neurosurg

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ObjectiveThe aim of this study is to introduce a microvascular training model based on use of materials that can be easily obtained from the daily surroundings.MethodsSimple microinstruments and a medical school laboratory microscope were used for anastomosis training. Chicken blood vessels were used as a material for this study. A long segment of blood vessel from the proximal brachial artery to the distal radial artery was used for training. End-to-side anastomosis was practiced first, and the training continued with end-to-end anastomosis of the appropriate segments.ResultsThe instruments used for setting up this model were simple and easy to use; therefore, the time required for preparation of the materials and dissection of the chicken wings was only approximately five to ten minutes. The characteristics of 20 chicken wings were analyzed. The length of the brachial artery to the radial artery was 8 - 10 cm. The average diameter of the brachial artery was 1.3 mm ± 0.2 mm and that of the radial artery was 1.0 mm ± 0.2 mm. Taking advantage of these characteristics, the proximal brachial artery was grafted to the radial artery for practice of end-to-side anastomosis.ConclusionsThis study suggests an effective and feasible method for microvascular anastomosis training using chicken wing arteries and simple microinstruments. This model may simulate the conditions of a superficial temporal artery to middle cerebral artery anastomosis surgery.

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An Anatomic Mathematical Measurement to Find an Adequate Recipient M4 Branch for Superficial Temporal Artery to Middle Cerebral Artery Bypass Surgery

Abstract: This study provides an anatomic and patient-independent mathematical measurement as a way to predictably find an adequate recipient temporal M4 branch for superficial temporal artery-MCA bypass in the majority of patients.

Cited by 9 publications

References 15 publications

Facing Time in Ischemic Stroke: An Alternative Hypothesis for Collateral Failure

Facing Time in Ischemic Stroke: An Alternative Hypothesis for Collateral Failure

Intraoperative Blood Flow Analysis of Direct Revascularization Procedures in Patients with Moyamoya Disease

An Efficient Microvascular Anastomosis Training Model Based on Chicken Wings and Simple Instruments

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