Intraoperative Resuturing of Occluded Superficial Temporal Artery−Middle Cerebral Artery Anastomoses: Single-Center Retrospective Study

Kimura, Toshikazu; Ibayashi, Kenji; Kawai, Kensuke

doi:10.1016/j.wneu.2018.02.114

Cited by 4 publications

(7 citation statements)

References 7 publications

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“…As demonstrated in the literature review, most patients choose to have the suture removed at the anastomotic site. [6,12,14,16] Kimura T employed direct surgical embolectomy to rescue 12 patients who developed acute thrombi. Of the 12 patients, 11 had intraoperative reperfusion [12] .…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Rescue Strategies for Acute Thrombosis in Moyamoya Patients during STA-MCA Bypass Surgery and the Literature Review

Xu,

Ni,

Zhou

et al. 2024

Preprint

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Background and objectives: Moyamoya disease is most improtantly treated with superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery, and the intraoperative patency of the reconstructive vessels is critical to the efficacy of the procedure. This study aimed to evaluate the efficacy of intra-arterially infused tirofiban for the treatment of acute thrombosis during STA-MCA bypass surgery and countermeasures for acute thrombosis. Methods: We retrospectively reviewed the clinical and imaging data, surgical procedure, and follow-up outcomes of eight patients who developed acute thrombosis during the surgical procedure. We implemented the different thrombolytic methods to evaluate the optimal thrombosis management during the bypass surgery. After three months, we assessed neurological functions using the modified Rankin Scale (mRS) and conducted a literature review using PubMed. Results: Eight patients (four male patients and four female patients) developed acute thrombosis during the bypass surgery. Of the eight patients, two underwent re-anastomosis after thrombus removal, three received local injections of tirofiban into the anastomosis or the branches of the superficial temporal artery, and three underwent superselective intra-arterial tirofiban infusion using a microcatheter. Thrombosis were resolved, and arteries were recanalized in all patients. The mRS score was 0 in all patients. No major ischemic or hemorrhagic complications occurred. Conclusion: Our treatment methods were efficacious in the management of acute thrombosis. Intra-arterial tirofiban administration seems to be a simple and effective treatment option for acute thrombosis during STA-MCA bypass surgery.

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Section: Discussionmentioning

confidence: 99%

“…Buchanan IA, et al, 2021 [11] abciximab Takahashi JC et al, 2022 [12] 1.Systemic heparinization. Nasogastric administration of aspirin.…”

Section: Literature Reviewmentioning

confidence: 99%

Analysis of Rescue Strategies for Acute Thrombosis in Moyamoya Patients during STA-MCA Bypass Surgery and the Literature Review

Xu,

Ni,

Zhou

et al. 2024

Preprint

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“…Noteworthy examples include the radial artery [20] and the saphenous vein [21], employed in treating complex intracranial aneurysms, and the occipital artery, utilized for addressing diseases in the posterior circulations [4]. Harvesting the donor vessel is a crucial procedure, as graft occlusion can lead to fatal complications [8].…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective study further examined the pathology of the STA harvested using the bipolar cutting/dissection method, providing histological evidence affirming the safety of the approach [7]. In these donor vessel revascularization procedures, vessel injury occurs during harvesting, and complications due to ischemic events have been reported [8]. However, there are no studies on the background and frequency of vascular injury.…”

Section: Introductionmentioning

confidence: 99%

“…Han et al reported cases of progressive stenosis and/or occlusion of the intracranial internal carotid artery diagnosed as moyamoya disease with coexisting atherosclerosis [12]. In relation to histological findings and diseases, there have been previous reports of intimal thickening in the STA with moyamoya disease [13], complications arising from abnormal STA grafts that could not be used as donor arteries for cerebral revascularization in middle cerebral artery stenosis [14,15], and damage to dissected vessels during the harvesting of donor vessels, resulting in anastomotic occlusion and intraoperative thrombosis [8]. There are limited reports on the effects of the histological findings of donor vessels on anastomosis, and there are no reports on the effects of underlying diseases, such as atherosclerosis, moyamoya disease, and aneurysms.…”

Section: Introductionmentioning

confidence: 99%

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Pathological Findings of Donor Vessels in Bypass Surgery

Nounaka,

Murai,

Kubota

et al. 2024

JCM

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(1) Background Cerebral revascularization is necessary to treat intracranial arterial stenosis caused by moyamoya disease, atherosclerosis, or large complex aneurysms. Although various donor vascular harvesting methods have been reported safe, there are no reports on the histological evaluation of donor vessels for each disease, despite the variety of diseases wherein vascular anastomosis is required. (2) Methods Pathological findings of the superficial temporal artery (STA), radial artery (RA), occipital artery (OA), and saphenous vein (SV) harvested at the institution were analyzed. Patients classified according to aneurysm, atherosclerosis, and moyamoya disease were assessed for pathological abnormalities, medical history, age, sex, smoking, and postoperative anastomosis patency. (3) Results There were 38 cases of atherosclerosis, 15 cases of moyamoya disease, and 30 cases of aneurysm in 98 donor vessels (mean age 57.2) taken after 2006. Of the 84 STA, 11 RA, 2 OA, and 1 SV arteries that were harvested, 71.4% had atherosclerosis, 11.2% had dissection, and 10.2% had inflammation. There was no significant difference in the proportion of pathological findings according to the disease. A history of hypertension is associated with atherosclerosis in donor vessels. (4) Conclusions This is the first study to histologically evaluate the pathological findings of donor vessels according to disease. The proportion of dissection findings indicative of vascular damage due to surgical manipulation was not statistically different between the different conditions.

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Analysis of rescue strategies for acute thrombosis during STA-MCA bypass surgery and the literature review

Xu,

Ni,

Zhou

et al. 2024

Acta Neurochir

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Background and objectives STA-MCA bypass surgery is mainly used for Moyamoya disease, giant intracranial aneurysms, and resection of intracranial tumors requiring sacrifice of blood vessels. The intraoperative patency of the reconstructive vessels is critical to the efficacy of the procedure. This study aimed to evaluate the efficacy of intra-arterially infused tirofiban for the treatment of acute thrombosis during STA-MCA bypass surgery and countermeasures for acute thrombosis. Methods This study involved 209 patients (272 hemispheres) who underwent STA-MCA surgery between November 2020 and December 2023. Intraoperative acute thrombosis occurred in eight patients (3.83%,8 hemispheres). We retrospectively reviewed the clinical and imaging data, surgical procedure, and follow-up outcomes of eight patients. We implemented the different thrombolytic methods to evaluate the optimal thrombosis management during the bypass surgery. After three months, we assessed neurological functions using the modified Rankin Scale (mRS) and conducted a literature review using PubMed. Results Eight patients (four male patients and four female patients) developed acute thrombosis during the bypass surgery. Of the eight patients, two underwent re-anastomosis after thrombus removal, three received local injections of tirofiban into the anastomosis or the branches of the superficial temporal artery, and three underwent superselective intra-arterial tirofiban infusion using a microcatheter. Thrombosis were resolved, and arteries were recanalized in all patients. The mRS score was 0 in all patients. No major ischemic or hemorrhagic complications occurred. Conclusion Our treatment methods were efficacious in the management of acute thrombosis. Intra-arterial tirofiban administration seems to be a simple and effective treatment option for acute thrombosis during STA-MCA bypass surgery.

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Intraoperative Resuturing of Occluded Superficial Temporal Artery−Middle Cerebral Artery Anastomoses: Single-Center Retrospective Study

Cited by 4 publications

References 7 publications

Analysis of Rescue Strategies for Acute Thrombosis in Moyamoya Patients during STA-MCA Bypass Surgery and the Literature Review

Analysis of Rescue Strategies for Acute Thrombosis in Moyamoya Patients during STA-MCA Bypass Surgery and the Literature Review

Pathological Findings of Donor Vessels in Bypass Surgery

Analysis of rescue strategies for acute thrombosis during STA-MCA bypass surgery and the literature review

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