Abstract
Superficial temporal artery-middle cerebral artery (STA-MCA) has been used for the treatment of occlusive cerebrovascular disease including moyamoya disease. The effect of STA-MCA bypass depends not only on the patency of anastomosis, but also on integrity and functional capacity of the donor artery. In the present prospective study, we investigated the effect of extensive stripping STA adventitia and fasciae on hemodynamic function in STA-MCA bypass of moyamoya disease patients. Twenty patients (n=8 in control group, n=12 in stripping group) of moyamoya disease were subjected to STA-MCA end-to-side direct anastomosis. Perfusion unit (PU) values of the cortex were measured and recorded using a Laser Doppler flowmetry (LDF) for 5 days. Computed tomography perfusion was performed to determine blood flow before and after bypass. No patient experienced significant neurologic deficits associated with neurosurgical complications. LDF demonstrated that adventitial stripping group had higher cerebral blood flow increase than control group. The adventitia stripping group tends to have higher rate of increased cerebral perfusion after bypass than non-stripping group. Furthermore, the ultrasound examination at 3 days after bypass demonstrated that the adventitial stripping group has a tendency of bigger STA and higher peak systolic velocity than control group. Our result suggests that stripping adventitia of STA improves hemodynamics of STA-MCA bypass in moyamoya disease.
Highlights
Superficial temporal artery-middle cerebral artery (STAMCA) bypass surgery is a technique that allows low blood flow supply from the extracranial carotid to the distal MCA [1, 2]
In the last two decades, the modern technological advancements such as Laser Doppler flowmetry (LDF) [4, 5, 8], infrared camera thermography [8], and quantitative MRA [9] for hemodynamic measurement have allowed us to reappraise the effect of Superficial temporal artery-middle cerebral artery (STA-MCA) bypasses on cerebrovascular disease [10, 11]
There is increasing evidence indicated that STA-MCA bypasses improve neurological function and prevent stroke recurrence in subgroup patients of cerebrovascular disease [12,13,14,15,16,17,18]
Summary
CHS, cerebral hyperperfusion syndrome; CTA, computed tomographic arteriography; DSA, digital subtraction angiography; F, female; ICGA, indocyanine green angiography; L, left; M, male; mRS, modified Rankin Scale; Postop, postoperative; Preop, preoperative; R, right; rCBF regional cerebral blood flow; SAH, subarachnoid hemorrhage; STA-MCA, superficial temporal artery-middle cerebral artery; TIA, transient ischemic attack; +, patent; ++, highly patent. Twenty patients of moyamoya disease underwent STA– MCA bypass at Beijing Tiantan Hospital from 2012 to 2013 were included in the present study, in which 9 were male and 11 were female (age range, 22 to 58 years; mean age, 41.19 years) (Table 1). The main symptoms were ischemic stroke in 17 and hemorrhagic stroke in 3 patients. All patients were diagnosed of moyamoya disease by digital subtraction angiography (DSA), magnetic resonance imaging (MRI), computed tomography (CT), and computed tomography perfusion (CTP)
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