Continuous Interrupted Double Throw Suturing Method: A Novel Suturing Technique for Extracranial-Intracranial Bypass

Abstract

Despite failure of the EC/IC Bypass Study Group to demonstrate effectiveness in minimizing future stroke events, superior temporal artery-medial cerebral artery (STA-MCA) bypass remains an essential treatment for complex giant intracranial aneurysms, tumors, moyamoya disease with ischemia, and atherosclerotic steno-occlusive disease with hemodynamic cerebrovascular insufficiency. The objective of this report is to describe a novel suturing technique for STA-MCA bypass that helps reduce donor-recipient anastomosis time, allowing for a well-organized systematic workflow. Step 1 involves passing the needle of a 9-0 polypropylene suture from out-to-in on the donor vessel followed by in-to-out on the recipient vessel. Step 2: Before cutting and tying a knot as per the established method of suturing, repeat step 1 and leave the needle "parked", creating a loop that is then cut at its proximal end. Step 3: Tie knots using the jeweler's forceps. Repeat previous steps until there are enough throws to seal the bypass adequately. The STA-MCA bypass serves as a principal method for flow augmentation. The technique described here allows for more efficient and organized microsurgical movements reducing vessel tissue manipulation and clamp time. We describe a novel technique for interrupted STA-MCA bypass suturing that adds efficiency, safety, organization, and operative ease compared with the conventional method of interrupted vessel suturing.