Superficial temporal artery to middle cerebral artery bypass with interposed saphenous vein graft in patients with atherosclerotic internal carotid artery occlusive disease and impaired cerebral hemodynamics.

Abstract

The aim of this study was to evaluate the efficacy of interposed saphenous vein graft (SVG) usage during extracranial-intracranial (EC-IC) bypass surgery in patients with cerebral ischemia and appropriate donor artery absence. Since October 2010 till January 2014, 62 EC-IC bypass surgeries were applied in 60 patients. In nineteen patients SVG was used to create low-flow bypasses between superficial temporal artery trunk and cortical segment of middle cerebral artery. SVG was used due to inappropriate diameter of scalp artery in 12 cases, inadequate flow in intended donor artery in 5 patients and in 2 cases for other reasons. Indications for revascularization were based on clinical symptoms of cerebral hemodynamics impairment, confirmed with transcranial duplex ultrasonography (DUS) and brain perfusion computed tomography (CT). Early bypass patency was confirmed with DUS up to 9 postoperative day in 16 patients. In 3 (15.8%) patients blood flow was not visualized. Bypass patency in these patients was confirmed with repeated DUS up to 42 months period. At mean clinical follow-up of 22.3 months 14 patients (73.7%) reported an improvement of their condition, 4 patients (21%) didn't observe any changes in well-being and 1 patient (5.3%) got worse. Late bypass patency assessment was available and confirmed in 16 patients at mean follow-up of 15.6 months postoperation. Repeated brain perfusion CT was performed in 10 patients at mean follow-up of 5.2 months. Average growth of regional cerebral blood flow was 24.1%. The use of interposed SVG bypass for EC-IC revascularization is an effective method, that could be applied in patients with cerebral ischemia caused by internal carotid artery occlusive disease and absence of appropriate donor artery.