DOI QR코드

DOI QR Code

Assessing the Adequacy of Superficial Temporal Artery Blood Flow in Korean Patients Undergoing STA-MCA Anastomosis

  • Jin Eun (Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Ik Seong Park (Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2023.06.19
  • Accepted : 2023.09.04
  • Published : 2024.03.01

Abstract

Objective : Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is conducted for flow augmentation. In this study, we measured the STA cut flow of a Korean population and evaluated the relationship between STA cut flow and long-term patency of the bypass. Methods : A retrospective study was conducted. Intraoperative measurement of STA flow was conducted using a microvascular flow meter on patients who underwent STA-MCA. After cutting the distal end, the STA flow rate was measured with no resistance and recorded. After finishing anastomosis, STA flow was measured and recorded. The cut flow index was calculated by dividing post anastomosis flow by cut flow in intracranial atherosclerotic stenosis patients. Results : The median STA cut flow was 35.0 mL/min and the post anastomosis flow was 24.0 mL/min. The cut flow of STA decreased with aging (p=0.027) and increased with diameter (p=0.004). The cut flow showed no correlation with history of hypertension or diabetes mellitus (p=0.713 and p=0.786), but did correlate a positively with history of hyperlipidemia (p=0.004). There were no statistical differences in cut flow, STA diameter, and post anastomosis flow between the frontal and parietal branches (p=0.081, p=0.853, and p=0.990, respectively). Conclusion : The median STA cut flow of a Korean population was 35 mL/min. Upon reviewing previous articles, it appears that there are differences in the STA cut flow between Western and Asian patients.

Keywords

References

  1. Amin-Hanjani S, Du X, Mlinarevich N, Meglio G, Zhao M, Charbel FT : The cut flow index: an intraoperative predictor of the success of extracranial-intracranial bypass for occlusive cerebrovascular disease. Neurosurgery 56(1 Suppl) : 75-85; discussion 75-85, 2005 https://doi.org/10.1227/01.NEU.0000143032.35416.41
  2. Beverly JK, Budoff MJ : Atherosclerosis: pathophysiology of insulin resistance, hyperglycemia, hyperlipidemia, and inflammation. J Diabetes 12 : 102-104, 2020 https://doi.org/10.1111/1753-0407.12970
  3. Hage ZA, Behbahani M, Amin-Hanjani S, Charbel FT : Carotid bypass for carotid occlusion. Curr Atheroscler Rep 17 : 36, 2015
  4. Helthuis JHG, van Doormaal TPC, Amin-Hanjani S, Du X, Charbel FT, Hillen B, et al. : A patient-specific cerebral blood flow model. J Biomech 98 : 109445, 2020
  5. Kuriyama S, Kusaka Y, Fujimura M, Wakai K, Tamakoshi A, Hashimoto S, et al. : Prevalence and clinicoepidemiological features of moyamoya disease in Japan: findings from a nationwide epidemiological survey. Stroke 39 : 42-47, 2008 https://doi.org/10.1161/STROKEAHA.107.490714
  6. Liu JK, Kan P, Karwande SV, Couldwell WT : Conduits for cerebrovascular bypass and lessons learned from the cardiovascular experience. Neurosurg Focus 14 : e3, 2003
  7. Markert MS, Della-Morte D, Cabral D, Roberts EL Jr, Gardener H, Dong C, et al. : Ethnic differences in carotid artery diameter and stiffness: the Northern Manhattan study. Atherosclerosis 219 : 827-832, 2011 https://doi.org/10.1016/j.atherosclerosis.2011.08.028
  8. Matsukawa H, Tanikawa R, Kamiyama H, Tsuboi T, Noda K, Ota N, et al. : The valveless saphenous vein graft technique for EC-IC high-flow bypass: technical note. World Neurosurg 87 : 35-38, 2016 https://doi.org/10.1016/j.wneu.2015.12.009
  9. Mohit AA, Sekhar LN, Natarajan SK, Britz GW, Ghodke B : High-flow bypass grafts in the management of complex intracranial aneurysms. Neurosurgery 60(2 Suppl 1) : ONS105-ONS122; discussion ONS122-ONS123, 2007 https://doi.org/10.1227/01.NEU.0000249243.25429.EE
  10. Okada Y, Shima T, Nishida M, Yamane K, Yamada T, Yamanaka C : Effectiveness of superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya disease: cerebral hemodynamics and clinical course in ischemic and hemorrhagic varieties. Stroke 29 : 625-630, 1998 https://doi.org/10.1161/01.STR.29.3.625
  11. Sekhar LN, Natarajan SK, Ellenbogen RG, Ghodke B : Cerebral revascularization for ischemia, aneurysms, and cranial base tumors. Neurosurgery 62(6 Suppl 3) : SHC1373-SHC1410; discussion 1408-1410, 2008 https://doi.org/10.1227/01.NEU.0000315873.41953.74
  12. Stapleton CJ, Atwal GS, Hussein AE, Amin-Hanjani S, Charbel FT : The cut flow index revisited: utility of intraoperative blood flow measurements in extracranial-intracranial bypass surgery for ischemic cerebrovascular disease. J Neurosurg 133 : 1396-1400, 2019 https://doi.org/10.3171/2019.5.JNS19641
  13. Tulleken CA, van der Zwan A, Kappelle LJ : High-flow transcranial bypass for prevention of brain ischemia. Ned Tijdschr Geneeskd 143 : 2281-2285, 1999
  14. Unda SR, Antoniazzi AM, Fluss R, Yassari N, Esenwa C, Haranhalli N, et al. : Ethnic-associated phenotype variations in moyamoya cerebrovascular outcomes. Cerebrovasc Dis 52 : 519-525, 2023 https://doi.org/10.1159/000528055
  15. Wang G, Zhang X, Wang B, Wen Y, Chen S, Liu J, et al. : Flow evaluation of STA-MCA bypass using quantitative ultrasonography: an alternative to standard angiography for follow up of bypass graft. J Stroke Cerebrovasc Dis 29 : 105000, 2020
  16. Zechariah A, ElAli A, Hagemann N, Jin F, Doeppner TR, Helfrich I, et al. : Hyperlipidemia attenuates vascular endothelial growth factor-induced angiogenesis, impairs cerebral blood flow, and disturbs stroke recovery via decreased pericyte coverage of brain endothelial cells. Arterioscler Thromb Vasc Biol 33 : 1561-1567, 2013  https://doi.org/10.1161/ATVBAHA.112.300749