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DOI: 10.1055/s-0037-1598050
Superficial Temporal Artery-Middle Cerebral Artery Bypass Using a Thick STA after Endarterectomy: A Rescue Technique
Publikationsverlauf
24. Mai 2016
31. Oktober 2016
Publikationsdatum:
06. Juni 2017 (online)
![](https://www.thieme-connect.de/media/jnlsa/201706/lookinside/thumbnails/10-1055-s-0037-1598050_161692tn-1.jpg)
Abstract
Background and Objective Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is a procedure to reconstruct cerebral blood flow in the MCA territory. In some cases, the STA wall is thickened and the size discrepancy between STA and MCA is apparent. In such a situation, STA-MCA bypass is challenging. We present two patients who underwent STA-MCA bypass using STA in which a thickened intima was removed. We discuss the usefulness of this rescue technique.
Patients and Results A patient with an atherosclerotic MCA occlusion and another with an occluded internal carotid artery are included. Endarterectomy of STA was performed before or during anastomosis, and the intima-resected STA was anastomosed to MCA. In both cases, the STA was thick and hard, and it was difficult to anastomose the STA as it was to the MCA. Patency of the bypass was confirmed by postoperative angiography.
Conclusion Endarterectomy of a thickened STA might be an effective rescue technique in cases with severely atherosclerotic STA in STA-MCA bypass.
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References
- 1 Kletter G, Meyermann R, Koos WT, Schuster H. The importance of the histological structure of the superficial temporal artery for the functioning of the arterial extra-intracranian anastomosis [in French]. Neurochirurgie 1975; 21 (07) 551-556
- 2 Mehdorn HM, Wiedemeyer H, Reinhardt V, Gerhard L, Zais E. Histological changes in the superficial temporal artery and their significance for extracranial-intracranial bypass operations [in German]. Neurochirurgia (Stuttg) 1983; 26 (06) 181-186
- 3 Steinbok P, Berry K, Dolman CL. Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. Pathological study of two cases. J Neurosurg 1979; 50 (03) 377-381
- 4 Aoyagi M, Fukai N, Yamamoto M, Nakagawa K, Matsushima Y, Yamamoto K. Early development of intimal thickening in superficial temporal arteries in patients with moyamoya disease. Stroke 1996; 27 (10) 1750-1754
- 5 Reddy S, Kumar P, Prasad K. Histomorphometric and sympathetic innervation of the human superficial temporal artery. Indian J Plast Surg 2011; 44 (01) 127-133
- 6 Levinthal R, Gregorius FK. Intimal dissection of the superficial temporal artery. Surg Neurol 1978; 9 (04) 268-269
- 7 Moritake K, Gratzl O. Morphological and clinical analysis of extra-intracranial bypass. 2. Histological and histometrical evaluation with correlation of angiographical findings. Arch Psychiatr Nervenkr (1970) 1982; 232 (04) 341-357
- 8 Diaz FG, Chason J, Shrontz C, Ausman JI, Dujovny M. Histological structural abnormalities of superficial temporal arteries used for extracranial-intracranial anastomosis. J Neurosurg 1982; 57 (03) 328-333
- 9 Matsumura N, Shibata T, Kamiyama H. , et al. Higher magnification microsurgical repair of donor artery dissection in superficial temporal artery to middle cerebral artery anastomosis—technical note. Neurol Med Chir (Tokyo) 2011; 51 (12) 872-874
- 10 Dirrenberger RA, Sundt Jr TM. Carotid endarterectomy. Temporal profile of the healing process and effects of anticoagulation therapy. J Neurosurg 1978; 48 (02) 201-219
- 11 Amin-Hanjani S, Charbel FT. Flow-assisted surgical technique in cerebrovascular surgery. Surg Neurol 2007; 68 (Suppl. 01) S4-S11