Is Precise Targeting of the Recipient Artery in a Superficial Temporal Artery–Middle Cerebral Artery Anastomosis Crucial?

Hiroyuki Katano; Hiroshi Yamada; Yusuke Nishikawa; Kazuo Yamada; Shigenori Miyachi; Mitsuhito Mase

doi:10.1055/s-0039-1685169

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2019; 80(06): 441-453
DOI: 10.1055/s-0039-1685169

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Is Precise Targeting of the Recipient Artery in a Superficial Temporal Artery–Middle Cerebral Artery Anastomosis Crucial?

Hiroyuki Katano

¹Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Aichi, Japan

²Department of Medical Informatics and Integrative Medicine, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Aichi, Japan

,

Hiroshi Yamada

¹Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Aichi, Japan

,

Yusuke Nishikawa

¹Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Aichi, Japan

,

Kazuo Yamada

³Department of Neurosurgery, Nagoya City Rehabilitation Center, Nagoya, Aichi, Japan

,

Shigenori Miyachi

⁴Department of Central Radiology, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Aichi, Japan

,

Mitsuhito Mase

¹Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences and Medical School, Nagoya, Aichi, Japan

› Author Affiliations

Abstract

Objective To investigate the difference in treatment outcomes according to the method used to select the recipient artery in superficial temporal artery–middle cerebral artery (STA-MCA) anastomoses.

Methods We retrospectively analyzed the cases of 35 patients who underwent an STA-MCA anastomosis for internal carotid artery/MCA occlusion or stenosis. Patients were divided into two groups based on whether the recipient artery was precisely targeted by single-photon emission computed tomography (SPECT group) or less precisely targeted by visual assessment (Visual group). Then the bypass results in both groups were evaluated postoperatively based on changes in the regional cerebral blood flow (rCBF) and clinical outcomes.

Results The delineated recipient artery in magnetic resonance angiography (MRA) matched the intraoperatively selected artery in 87.6% of the SPECT group cases and 83.3% of the Visual group cases. The SPECT group's digital subtraction angiography (DSA) findings coincided with the intraoperative selection in 76.9% of cases, and the MRA findings corresponded with the DSA findings in 92.3%. The postoperative areas with increased rCBF matched the perfused areas of intraoperatively selected arteries in 80.0% of the SPECT group cases and 77.8% of the Visual group cases. Postoperatively increased rCBF areas matching totally or partially with preoperative low-perfusion areas were observed in all cases.

Conclusions The present results revealed no significant differences in the change in rCBF in the low-perfusion area between the patients whose recipient arteries were selected by SPECT or visual assessment.

Keywords

EC-IC bypass - IC occlusion - MCA occlusion - MCA stenosis - SPECT - STA-MCA anastomosis - target bypass

Full Text

References

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