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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan. Electronic address: iakihiro3@gmail.com.
Akihiro
A
Inoue
Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Kanehisa
K
Kohno
Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Shinji
S
Iwata
Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Shiro
S
Ohue
Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Saya
S
Ozaki
Department of Neurology, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Satoko
S
Ninomiya
Department of Neurology, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Hitomi
H
Tomita
Department of Neurology, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Kenji
K
Kamogawa
Department of Neurology, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Kensho
K
Okamoto
Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Shinya
S
Fukumoto
Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Haruhisa
H
Ichikawa
Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Shinji
S
Onoue
Department of Neurosurgery, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Yawara
Y
Nakamura
Department of Neurology, Ehime Prefectural Central Hospital, Ehime Prefecture, Japan.
Bungo
B
Okuda
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation / Q000502:physiology; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D013699:Temporal Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon
Main trunk artery occlusion for atherosclerosis; early superficial temporal artery–middle cerebral artery double anastomoses; progressing stroke; subacute stage