Intraoperative middle cerebral artery pressure measurements during superficial temporal artery to middle cerebral artery bypass procedures in patients with cerebral atherosclerotic disease

Abstract

OBJECTIVE No previous study has monitored middle cerebral artery (MCA) pressure during the superficial temporal artery (STA)-MCA bypass procedure for cerebral atherosclerotic disease. In this paper, the authors describe their method of monitoring MCA pressure and report their initial data on intraoperative MCA pressure and its relationship with hemodynamics prior to and after the bypass procedures. METHODS The results from a total of 39 revascularization procedures performed between 2004 and 2014 were analyzed. The patient group included 27 men and 12 women, and their mean age at surgery was 67.6 years (range 39-83 years). The authors investigated the MCA pressure via the STA during STA-MCA bypass procedures. After one branch of the STA was anastomosed to the MCA, the other branch was connected to an arterial line, and a clip was placed temporally on the main STA trunk to monitor the pre-anastomosis MCA pressure. Simultaneously, the radial artery (RA) pressure was determined before removing the temporal clip to measure the post-anastomosis MCA pressure. The relationship between MCA pressures and single photon emission computed tomography findings and the risk factors for hyperperfusion after STA-MCA bypass were analyzed. RESULTS The MCA/RA (%) pressure was significantly correlated with that of the resting stenotic/normal side cerebral blood flow (CBF) ratio (%) in the linear regression analysis (slope 1.200, r = 0.3564, F = 20.49, p < 0.0001). The intraoperative MCA pressure was 39.3% of RA pressure in patients with Powers' Stage 2 cerebral atherosclerotic disease. After 1 branch of the STA was anastomosed, the intraoperative MCA pressure increased to 75.3% of the RA pressure. The rate of increase in pressure was significantly correlated with the increase in the STA diameter in the linear regression analysis (slope 2.59, r = 0.205, F = 9.549, p = 0.0038). Hyperperfusion occurred in 2 cases. When mean values for these 2 patients were compared with those for the 37 patients without hyperperfusion, significant differences were found in the stenotic/normal side CBF ratio (p = 0.0001), pre-anastomosis MCA pressure (p = 0.02), rate of increase in pressure (p = 0.02), pre-anastomotic MCA/RA pressure ratio (p = 0.01), vascular reserve (p = 0.0489), and STA diameter (p = 0.0002). CONCLUSIONS The measurement of intraoperative MCA pressure may be a useful technique to assess cerebral perfusion and for predicting the risk of hyperperfusion. Monitoring MCA pressure is recommended during STA-MCA bypass procedures for atherosclerotic disease.

Cross-Comparison of 4-Dimensional Flow Magnetic Resonance Imaging and Intraoperative Middle Cerebral Artery Pressure Measurements Before and After Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery

“…In this severe condition, autoregulation was not able to maintain CBF within the normal limit. 10,13 The relationship between CPP and CBF is established, but was first confirmed in the current study by directly monitoring CPP in Vivo. From another point of view, even when blood pressure increased twice, there was no increase or sometimes decrease in BFV.…”

Factors Influencing Long-Term Blood Flow in Extracranial-to-Intracranial Bypass for Symptomatic Internal Carotid Artery Occlusive Disease: A Quantitative Study

“…Indications for STA-MCA bypass for symptomatic ICA/MCA occlusive disease were based on the 2009 and 2015 Japanese Guidelines for the Management of Stroke 4,11,23 (tentative translation). When performed by a skilled surgeon without perioperative complications, EC-IC bypass is recommended only for patients with all the following indications:patients younger than 73 years with a modified Rankin Scale of 1 or 2 who have had a minor stroke within the past 3 months because of the ICA occlusive lesion;angiographic evidence of occlusion or severe stenosis of the ICA or M1 of the MCA, without evidence of extensive cerebral infarction over a single-vessel dominant territory on computed tomography (CT) or MRI; andpatients with impaired cerebral circulatory reserve with resting CBF in the MCA less than 80% of the normal and acetazolamide cerebrovascular reactivity and less than 10% on quantitative cerebral perfusion measurements using positron emission tomography, single-photon emission CT (133Xe or 123I-IMP), or cold xenon CT performed at least 3 weeks after the last attack.…”

“…The basic surgical strategy was STA-MCA double anastomosis. 4,11,14,15 To prevent postoperative hyperperfusion and cerebral hemorrhage, we adopted a policy of elective double bypass, as follows. 11 After completing one anastomosis with the larger STA, the other branch of the STA was connected to the arterial line, and preanastomotic MCA cerebral surface pressure was monitored before commencing the second bypass.…”

The use of high-flow extracranial-intracranial artery bypass in pathology of the cerebral and brachiocephalic arteries: technical features and surgical outcomes

“…Для этого после откидывания кожного лоскута или на этапе кожного разреза выделяется одна из ветвей ПВА (предпочтительно теменная). При планировании прямого измерения АД в интракраниальных артериях [44] необходимо выделить обе ветви ПВА, а также хотя бы небольшой участок (3-4 мм) ее ствола. Выделенные ветви донорской артерии не пересекают до момента создания микроанастомоза.…”