Prediction of flow augmentation and complications of extracranial–intracranial bypass in symptomatic cerebrovascular diseases

Chiu, Ted H.; Tsai, Sheng-Tzung; Chiu, Cheng-Hui

doi:10.1016/j.jocn.2011.08.031

Cited by 4 publications

(3 citation statements)

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“…Cerebral revascularization with good preparation can reduce the ischemic rate after bypass surgery [ 4 18 ]. However, without good preparation, the benefits of emergency bypass may be offset [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…False-negative results can lead to symptomatic infarctions after parent artery trapping in aneurysm surgery without bypass. In our hospital, STA-MCA bypass for atherosclerotic cerebrovascular disease resulted in stable surgical outcomes, including low complication rate and high patency rate [ 18 ]. Therefore, we changed our treatment policy for patients with complex or large aneurysms.…”

Section: Discussionmentioning

confidence: 99%

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Superficial temporal artery-middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms

2018

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Objectives:Direct microsurgical clipping for complex middle cerebral artery (MCA) aneurysms may require a long ischemic time. Sacrifice of the parent artery with trapping or endovascular coiling also may lead to ischemic stroke. We described our institutional experience with the treatment of complex MCA aneurysms using extracranial-intracranial (EC-IC) (superficial temporal artery [STA]-MCA) bypass.Materials and Methods:We retrospectively reviewed patients who had treatment of IC aneurysms with the assistance of STA-MCA bypass from July 2002 to December 2016. Six patients with complex MCA aneurysms were identified, and we reviewed their clinical characteristics.Results:There were three men and three women with age ranging from 27 to 59 (mean 49) years old. Image studies showed subarachnoid hemorrhage in three cases. All patients underwent STA-MCA anastomosis, and the follow-up period ranged from 2 to 116 months (mean 51.5 months). Two of the six MCA aneurysms were fusiform, two aneurysms had bizarre configurations, one was a dissecting saccular aneurysm, and one had a blister configuration. Three patients received direct vessel trapping, two patients received aneurysm clipping, and one received aneurysm coiling. The postoperative bypass patency rate was 100%. The modified Rankin scale showed good outcomes in the six patients.Conclusions:EC-IC bypass plays an important role as a salvage procedure in the treatment of complex MCA aneurysms which have a fusiform, bizarre, or blister configuration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Superficial temporal artery-middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms

2018

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“…The finding that low perfusion and poorer cerebrovascular reactivity were as-sociated with the risk of hyperperfusion is consistent with findings of previous studies. 6,34 There are few reports of the diameter of the donor vessel and the blood supply as risk factors for hyperperfusion. When we analyzed the STA diameter at 2 cm from the bifurcation, the intraoperative STA pressure was almost the same as the RA pressure (p = 0.69; data not shown).…”

Section: Discussionmentioning

confidence: 99%

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

Matano

Murai

Tanikawa

et al. 2016

JNS

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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.

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Extracranial–intracranial bypass in the treatment of complex or giant internal carotid artery aneurysms

Lee¹,

Chiu²,

Tsai³

et al. 2015

Tzu Chi Medical Journal

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Prediction of flow augmentation and complications of extracranial–intracranial bypass in symptomatic cerebrovascular diseases

Cited by 4 publications

References 30 publications

Superficial temporal artery-middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms

Superficial temporal artery-middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms

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

Extracranial–intracranial bypass in the treatment of complex or giant internal carotid artery aneurysms

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