Efficacy of Early Superficial Temporal Artery–Middle Cerebral Artery Double Anastomoses for Atherosclerotic Occlusion in Patients with Progressing Stroke

• Published in: Journal of stroke and cerebrovascular diseases Vol. 26; no. 4; pp. 741 - 748
• Main Authors: Inoue, Akihiro, Kohno, Kanehisa, Iwata, Shinji, Ohue, Shiro, Ozaki, Saya, Ninomiya, Satoko, Tomita, Hitomi, Kamogawa, Kenji, Okamoto, Kensho, Fukumoto, Shinya, Ichikawa, Haruhisa, Onoue, Shinji, Nakamura, Yawara, Okuda, Bungo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: Adult; Aged; Anastomosis, Surgical - methods; Cardiovascular; Cerebral Revascularization; Cerebrovascular Circulation - physiology; Cohort Studies; Diffusion Magnetic Resonance Imaging; early superficial temporal artery–middle cerebral artery double anastomoses; Female; Humans; Intracranial Arteriosclerosis - complications; Magnetic Resonance Angiography; Main trunk artery occlusion for atherosclerosis; Male; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - surgery; Neurology; progressing stroke; Stroke - diagnostic imaging; Stroke - etiology; Stroke - surgery; subacute stage; Temporal Arteries - diagnostic imaging; Temporal Arteries - surgery; Tomography, Emission-Computed, Single-Photon; progressing stroke; early superficial temporal artery–middle cerebral artery double anastomoses; Main trunk artery occlusion for atherosclerosis; subacute stage
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.009

We investigated the efficacy of early superficial temporal artery–middle cerebral artery (STA–MCA) double anastomoses for patients with progressing stroke due to atherosclerotic occlusion. Nine consecutive patients who underwent early STA–MCA double anastomoses were enrolled. All patients presented with progressing stroke despite maximal medical treatment. Cerebral blood flow in 7 patients was analyzed by single-photon emission tomography. Clinical outcomes were investigated postoperatively, and we evaluated the utility of early STA–MCA double anastomoses. Nine patients in the present study included those with middle cerebral artery occlusion (n = 6) and internal carotid artery occlusion (n = 3). The mean age was 58.4 years. Subjects comprised 1 female (11.1%) and 8 males (88.9%). The cause was low perfusion ischemia due to atherosclerotic occlusion with a small infarct. The mean regional cerebral blood flow (rCBF) ratio in the middle cerebral artery territory compared to the normal side was 69.6 ± 5.3%. The duration from onset to surgery was 1-8 days (median, 3.11 days). All patients underwent early STA–MCA double anastomoses, and no reperfusion-induced hemorrhage occurred. All of them slowly achieved obvious remission compared to symptoms on admission and achieved a good functional outcome. Early STA–MCA double anastomoses were safe and effective, and early revascularization resulted in rapid neurological improvement. We recommend this procedure for patients with progressive ischemia due to main trunk artery occlusion, when the rCBF flow ratio with the normal side was 70 ± 10%, even at the subacute stage.