Side-to-side anastomosis of superficial temporal artery and middle cerebral artery bypass using in-situ intravascular suture technique: a report of 10 cases
10.3760/cma.j.cn441206-20241203-00264
- VernacularTitle:运用原位腔内缝合技术进行颞浅动脉-大脑中动脉侧侧吻合10例
- Author:
Zongyu XIAO
1
;
Liang HE
;
Ji WANG
;
Yang LIU
;
Yulun HUANG
;
Zhimin WANG
;
Haiping ZHU
;
Likui SHEN
Author Information
1. 苏州大学附属第四医院（苏州市独墅湖医院）神经外科,苏州 215123
- Publication Type:Journal Article
- Keywords:
Vascular anastomosis;
Side-to-side anastomosis;
Superficial temporal artery;
Middle cerebral artery;
Moyamoya disease
- From:
Chinese Journal of Microsurgery
2025;48(4):405-411
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the feasibility and clinical efficacy of side-to-side anastomosis of superficial temporal artery (STA) and middle cerebral artery (MCA) bypass using in-situ intravascular suture technique.Methods:A retrospective analysis was conducted on the clinical data of 10 adult patients who were treated with side-to-side microvascular anastomosis of STA-MCA bypass to improve intracranial blood supply, between February 2024 and September 2024 in the Department of Neurosurgery of the Fourth Affiliated Hospital of Soochow University. Among the patients, 2 were of symptomatic MCA occlusion and 8 of Moyamoya disease. Diameter of STA and MCA, length of anastomosis and blocking time of MCA were recorded. Indocyanine green video angiography (ICG-VA) was performed to evaluate the immediate patency of the STA-MCA side-to-side anastomosis. Digital subtracted angiography (DSA) was performed at 1 week after the surgery to evaluate the patency of the STA-MCA bypass anastomosis, then follow-up DSA was performed at 1, 3 and 6 months after surgery to further evaluate the postoperative anastomotic patency. Neurological function was evaluated regularly with the modified Rankin Scale (mRS).Results:All of the 10 side-to-side STA-MCA bypass anastomoses were successfully performed using in-situ intravascular suture technique. The scalps of all patients healed well. The diameters of STA and MCA were 1.4-2.0 (1.76±0.27) mm and 0.8-1.4 (0.98±0.20) mm, respectively. The average length of the anastomoses was 3.5-5.0 (4.45±0.60) mm. The blocking time of MCA was 12.0-29.0 (21.50±6.62) min. A 100% vessel patency rate was achieved immediately after vessel anastomosis and at 1 month after surgery. DSA examinations were performed at 3 months after surgery on 6 patients and at 6 months after surgery on 1 patient, and all the anastomoses were found in full patency. All patients were included in the postoperative follow-up that lasted for 3 to 7 months. All patients recovered well without new neurological dysfunction. The mRS of 8 patients remained at 0 point before and after surgery. Two patients had improved postoperative mRS of 1 point from that of 2 points before surgery.Conclusion:STA-MCA side-to-side microvascular bypass anastomosis can be performed safely and efficiently using in-situ intravascular suture technique. It could efficiently reduce the incidence of perioperative complications. Meanwhile, it can self-regulate the blood flow and maximise the potential capability of STA.
