title: Double-barrel bypass for cerebral ischemia: technique, rationale, and preliminary experience with 10 consecutive cases.
abstract: BACKGROUND
  In selected patients, extracranial-intracranial bypass remains an important treatment for the prevention of stroke. Traditionally, superficial temporal artery-middle cerebral artery (STA-MCA) bypass uses 1 STA branch. We have adopted a "double-barrel" technique in which both branches are joined with MCA recipients in distinct vascular territories.
  
  
  OBJECTIVE
  To assess the feasibility of routinely using both branches of the STA for cerebral revascularization.
  
  
  METHODS
  Ten consecutive patients underwent double-barrel bypass. Patients were selected if they demonstrated symptomatic MCA hypoperfusion resistant to medical therapy or had symptomatic moyamoya disease. Flow-directed bypass was performed to augment flow to the territories most at risk in each case, based on preoperative and intraoperative data. Computed tomography perfusion was routinely performed to evaluate baseline deficits and postoperative augmentation. Clinical data were analyzed to assess patient demographics and outcomes.
  
  
  RESULTS
  The double-barrel bypass was no more difficult technically than the traditional approach, with the second branch harvested through a small satellite incision. By isolating temporary occlusion to each territory, there was no additional ischemia to each brain region. No intraoperative complications or wound-healing issues occurred. Postoperative computed tomography perfusion studies all showed improvement, and delayed vascular imaging demonstrated universal graft patency. Nine of 10 patients have been asymptomatic since surgery, whereas 1 patient demonstrated symptoms in a separate vascular distribution.
  
  
  CONCLUSIONS
  Double-barrel STA-MCA bypass is both feasible and potentially advantageous. In our series, both bypass branches remained patent, augmenting flow to the territories most at need.
authors: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030, USA. edward.duckworth@bcm.edu
authors: Edward A M
authors: EA
authors: Duckworth
authors: Vikas Y
authors: VY
authors: Rao
authors: Akash J
authors: AJ
authors: Patel
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology / Q000601:surgery*; D013699:Temporal Arteries / Q000473:pathology / Q000601:surgery*; D055815:Young Adult