Superficial temporal-middle cerebral artery bypass: clinical pre- and postoperative angiographic correlation

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✓ Between 1974 and 1982, an anastomosis between a pedicle of the superficial temporal artery (STA) and a cortical branch of the middle cerebral artery (MCA) was performed in 163 carotid systems in 157 patients for internal carotid artery occlusion in whom postoperative angiograms were available for analysis. The angiographic opacification of the arterial system was correlated with the patient's preoperative neurological function and stroke in the follow-up period.

From this analysis, the following observations were made: 1) 96% of bypasses were patent; 2) 80% of bypasses achieved a high or medium MCA filling score; 3) there was hypertrophy of the STA in 70% of the cases; 4) greater bypass filling occurred in hemispheres with nonvisualized preoperative collateral circulation than in those with readily visualized collateral flow; 5) a meaningful correlation between angiographically assessed postoperative bypass function and stroke rate was not possible because only four patients suffered an ipsilateral hemispheric stroke in the 8-year follow-up period; and 6) patients who were neurologically unstable before the procedure were at greatest risk for a stroke in the follow-up period. It is apparent that objective analysis of the effectiveness of an STA-MCA bypass, or any other form of extracranial bypass, must await the development of new diagnostic studies in which high-resolution three-dimensional quantification of cerebral blood flow is possible. These studies will necessarily be correlated with preoperative and follow-up clinical data.

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Address reprint requests to: Thoralf M. Sundt, Jr., M.D., Cerebrovascular Research, 5-244 E.J., St. Mary's Hospital, Rochester, Minnesota 55902.

© AANS, except where prohibited by US copyright law.

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    Postoperative angiograms 6 days after surgery in a 57-year-old woman. This patient had a Grade 2 surgical risk preoperatively and improved after surgery. Filling of all six middle cerebral artery (MCA) vascular territories on the lateral view (left) and retrograde opacification of the lenticulo-striate and anterior cerebral arteries via bypass flow on the anteroposterior view (right) gave an MCA Bypass Filling Scale score of 8.

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    Angiograms in a 56-year-old man with Grade 2 surgical risk preoperatively who improved after surgery. Left: preoperative angiogram with common carotid artery injection, lateral view, demonstrating occlusion of the internal carotid artery and collateral filling of the carotid siphon and anterior cerebral artery via retrograde ophthalmic artery flow (small arrow). The superficial temporal artery (STA, large arrow) measured 1.5 mm in diameter. Right: Postoperative angiogram 8 days after surgery. The STA diameter has doubled (now 3 mm), and the ophthalmic collateral flow has decreased due to increased middle cerebral artery perfusion pressure caused by the bypass.

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