title: Long-term patency of superficial temporal artery to middle cerebral artery bypass for cerebral atherosclerotic disease: factors determining the bypass patent.
abstract: Long-term patency of superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery for atherosclerotic disease and associated risk factors for loss of patency have rarely been discussed. We retrospectively analyzed long-term patency following STA-MCA bypass and evaluated various demographic and clinical factors to identify the ones predictive of postsurgical loss of patency using records of 84 revascularization procedures (58 patients, 45 males; mean age at surgery 63.6 years, range 31-78 years). Bypass patency was diagnosed based on magnetic resonance angiography or three-dimensional computed tomography. The mean follow-up period was 24.7 months (range 6-63 months). Decreased bypass patency was observed in 4 of 58 patients (6.9 %) who collectively underwent 6 bypasses (7.1 %) of 84. All cases of decreased bypass patency were first detected within 6 months of surgery. Bypass patency was not correlated with age, sex, number of anastomoses, postoperative cerebral infarction, or control of postoperative diabetes mellitus. We found a significant association of bypass patency with hyperperfusion (p = 0.01) and postoperative smoking (p = 0.0036). Furthermore, we found a significant association of hyperperfusion with STA diameter (p < 0.0001), location of anastomosis (p = 0.075), and preoperative cerebral blood flow (p = 0.0399). In our retrospective study, hyperperfusion and smoking after surgery may be risk factors for decreased bypass patency in cerebral atherosclerotic disease patients. Careful monitoring of patency to prevent hyperperfusion and cessation of smoking are recommended, particularly within 6 months of the surgery.
authors.affiliation: Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. s00-078@nms.ac.jp.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Matano
authors.affiliation: Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Murai
authors.affiliation: Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Tateyama
authors.affiliation: Department of Neurological Surgery, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Tamaki
authors.affiliation: Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Mizunari
authors.affiliation: Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan.
authors.forename: Hideoshi
authors.initials: H
authors.lastname: Matsukawa
authors.affiliation: Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Teramoto
authors.affiliation: Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Morita
mesh_terms: D000328:Adult; D000368:Aged; D002548:Cerebral Revascularization / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000601:surgery*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D009072:Moyamoya Disease / Q000601:surgery*; D011184:Postoperative Period; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000601:surgery*
keywords: Aneurysm; Bypass; Middle cerebral artery; Moyamoya disease; Patency; Superficial temporal artery