Protective STA-MCA bypass to prevent brain ischemia during high-flow bypass surgery: case series of 10 patients

Aboukaïs, Rabih; Verbraeken, Barbara; Leclerc, Xavier; Gautier, C; Vermandel, Maximilien; Bricout, Nicolas; Lejeune, Jean‐Paul; Menovsky, Tomas

doi:10.1007/s00701-019-03906-4

Cited by 10 publications

(7 citation statements)

References 22 publications

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“…The recipient vessel in STA-MCA bypass surgery is the M4 branch. Therefore, after the anastomosis, it is presumed that the antegrade flow mainly supplies the cortical areas; whereas the retrograde flow mainly supplies the white matter along the M2 branch and the deep portion of the cerebral hemisphere, which is related to lateral lenticulostriate arteries [ 30 , 31 ]. These hemodynamic changes could be another reason why our results did not show a significant association between EP changes and PWI findings compared to previous studies.…”

Section: Discussionmentioning

confidence: 99%

Can Evoked Potential Changes during the Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery Predict Postoperative Improvement of Cerebral Perfusion and Functional Status?

et al. 2021

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Background: We investigated evoked potential (EP) changes during superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery and their correlations with imaging and clinical findings postoperatively. Methods: This retrospective study included patients who underwent STA-MCA bypass surgery due to ischemic stroke with large artery occlusion (MB group). Patients who underwent unruptured MCA aneurysm clipping were enrolled in the control group (MC group). Median and tibial somatosensory evoked potentials (SSEP), and motor evoked potentials recorded from the abductor pollicis brevis (APB-MEP) and abductor hallucis (AH-MEP) were measured intraoperatively. Modified Rankin scale (mRS) and perfusion-weighted imaging (PWI) related variables, i.e., mean transit time (MTT) and time to peak (TTP), were assessed. Results: Δmedian SSEP, ΔAPB-MEP, and ΔAH-MEP were significantly higher in the MB group than in the MC group (p = 0.027, p = 0.006, and p = 0.015, respectively). APB-MEP and AH-MEP amplitudes were significantly increased at the final measurement (p = 0.010 and p < 0.001, respectively). The ΔTTP asymmetry index was moderately correlated with ΔAPB-MEP (r = 0.573, p = 0.005) and ΔAH-MEP (r = 0.617, p = 0.002). ΔAPB-MEP was moderately correlated with ΔMTT (r = 0.429, p = 0.047) and ΔmRS at 1 month (r = 0.514, p = 0.015). Conclusions: MEP improvement during STA-MCA bypass surgery was partially correlated with PWI and mRS and could reflect the recovery in cerebral perfusion.

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Section: Discussionmentioning

confidence: 99%

Can Evoked Potential Changes during the Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery Predict Postoperative Improvement of Cerebral Perfusion and Functional Status?

et al. 2021

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“…To date, despite numerous variants of revascularizing techniques have been proposed 2,6,7,22 , there is no general strategy for their application to treat complex MCA aneurysms.…”

Section: Revascularization and Bypass Patencymentioning

confidence: 99%

Microsurgical management of complex middle cerebral artery aneurysms

et al. 2021

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Introduction Management of complex aneurysms of the middle cerebral artery (MCA) is very challenging and require individualized treatment strategies. The aim of our review was to analyze experience with the treatment of complex MCA aneurysms using revascularization and artery sacrifice techniques. Methods We have reviewed 9 original articles on patients' treatment with complex MCA aneurysms. Depending on localization of complex aneurysm of MCA various methods of parent artery sacrifice, revascularization strategies, surgical results, outcomes and complications were reviewed. Results We have analyzed treatment of 244 patients with 246 complex MCA aneurysms in 9 different groups. From 67 to 100% of cases the aneurysms were occluded successfully. Bypass patency being a result of the performed revascularization methods was from 83.3 to 100%. The main complications included ischemic disorders related to occlusion of the bypass graft or perforators injury. Morbidity in some reviews varied from 2.4 to 6.9%. The majority of patients in late follow-up showed good outcomes 0-2 on modified Rankin scale and 4-5 on Glasgow Outcome Scale. Illustrative clinical cases of the patients with complex MCA aneurysms treated at the Federal Neurosurgical Center were presented. Conclusion Complex aneurysms of the MCA are very challenging lesions. The surgical strategy for treating complex MCA aneurysm should take into account vascular anatomy, complex aneurysm morphology, its localization and rupture status of each case

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“…The protective STA-MCA bypass is mandatory to reduce the risk of perioperative ischemic complications. 27…”

Section: Protective Sta-mca Bypassmentioning

confidence: 99%

High-flow bypass using saphenous vein grafts with trapping of ruptured blood blister-like aneurysms of the internal carotid artery: patient series

Ishiguro

Yamaguchi

Ishikawa

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Trapping an aneurysm after the establishment of an extracranial to intracranial high-flow bypass is considered the optimal surgical strategy for ruptured blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA). For high-flow bypass surgeries, a radial artery graft is generally preferred over a saphenous vein graft (SVG). However, SVGs can be advantageous in acute-phase surgeries because of their greater length, easy manipulability, ability to act as high-flow conduits, and reduced risk of vasospasms. In this study, the authors presented five cases of ruptured BBAs treated with high-flow bypass using an SVG followed by BBA trapping, and they reported on surgical outcomes and operative nuances that may help avoid potential pitfalls. OBSERVATIONS After the surgeries, there were no ischemic or hemorrhagic complications, including symptomatic vasospasms. In three of the five cases, postoperative modified Rankin scale scores were between 0 and 2 at the 3-month follow-up. In one case, the SVG spontaneously occluded after surgery while the protective superficial temporal artery (STA) to middle cerebral artery (MCA) bypass became dominant, and the patient experienced no ischemic symptoms. LESSONS High-flow bypass using an SVG with a protective STA-MCA bypass followed by BBA trapping is a safe and effective treatment strategy.

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Protective STA-MCA bypass to prevent brain ischemia during high-flow bypass surgery: case series of 10 patients

Cited by 10 publications

References 22 publications

Can Evoked Potential Changes during the Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery Predict Postoperative Improvement of Cerebral Perfusion and Functional Status?

Can Evoked Potential Changes during the Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery Predict Postoperative Improvement of Cerebral Perfusion and Functional Status?

Microsurgical management of complex middle cerebral artery aneurysms

High-flow bypass using saphenous vein grafts with trapping of ruptured blood blister-like aneurysms of the internal carotid artery: patient series

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