Effect of extracranial-intracranial vascular bypass graft on experimental acute stroke in dogs

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✓ Anastomosis of the superficial temporal artery (STA) to a middle cerebral artery (MCA) branch was completed about 2 hours after occlusion of the MCA root in 20 dogs. Occlusion of the MCA root without bypass grafting was performed in 11 control animals. All dogs were evaluated clinically. Two days to 3 months (usually 2 weeks) after surgery, STA catheter angiograms were made and the animals sacrificed by perfusion fixation. The brains were evaluated pathologically. Animals with patent or occluded STA-MCA bypass grafts fared better both clinically and pathologically than the controls. Hemorrhagic infarction and blood-brain barrier damage were common in untreated dogs and uncommon in treated animals. STA-MCA bypass grafts rarely led to occlusion of intrinsic collateral blood supply to the brain. The data suggest that prompt STA-MCA branch anastomosis might lead to restoration of neurological function and parenchymal structural integrity in certain patients with acute middle cerebral artery occlusion.

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Address reprint requests to: Robert M. Crowell, M.D., Neurosurgical Service, Massachusetts General Hospital, Boston, Massachusetts 02114.

© AANS, except where prohibited by US copyright law.

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Figures

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    Macroscopic views of coronal sections at the level of the basal ganglia. Top: Grade 1 ischemic infarct in a dog with the left-sided patent graft 2 weeks postoperatively. Note absence of gross necrosis. Bottom: Grade 3 infarct with cortical hemorrhage in a control animal 2 weeks after MCA occlusion. Note gross involvement of subcortex and cortex.

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    Relation of clinical deficit to size of infarct. Note roughly linear relationship.

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