Acta Neurochirurgica

, Volume 156, Issue 1, pp 77–83 | Cite as

Clinical significance of STA-MCA double anastomosis for hemodynamic compromise in post-JET/COSS era

  • Satoshi Kuroda
  • Masahito Kawabori
  • Kenji Hirata
  • Tohru Shiga
  • Daina Kashiwazaki
  • Kiyohiro Houkin
  • Nagara Tamaki
Clinical Article - Vascular



Even after the recent randomized clinical trials JET and COSS, it is still unclear that impaired cerebrovascular reactivity (CVR) to acetazolamide and oxygen extraction fraction (OEF) can identify the candidates for superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. This prospective study was aimed to evaluate the benefits of STA-MCA “double” anastomosis on long-term outcome in patients with reduced cerebral blood flow (CBF) and CVR (Type 3 ischemia) and elevated OEF attributable to occlusive carotid diseases.


This study included 49 patients with reduced CBF and CVR on SPECT in the ipsilateral MCA area. Using 15O-gas PET, OEF was also measured in all patients. STA-MCA double anastomosis was recommended to the patients with Type 3 and elevated OEF. Those with Type 3 but normal OEF were medically treated.


Of 36 patients with Type 3 and elevated OEF, 25 consented to surgery. No perioperative morbidity or mortality were noted. The other 11 patients with Type 3 and elevated OEF were medically treated. Annual incidence of ipsilateral stroke was 0.7 % and 6.5 % in surgically and medically treated patients with Type 3 and elevated OEF, respectively (P = 0.0188). None of patients with Type 3 but normal OEF developed ipsilateral stroke during follow-up periods. STA-MCA “double” anastomosis significantly decreased OEF.


STA-MCA “double” anastomosis may still have the potential to reduce the risk of recurrent ipsilateral stroke in hemodynamically compromised patients. Further studies would be essential to advance diagnosis, surgical procedures, and perioperative managements to bring out maximal effects of bypass surgery.


STA-MCA anastomosis Acetazolamide Oxygen extraction fraction Bypass surgery 


Conflicts of interest


Disclosure of funding


Financial support and industry affiliations



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Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Satoshi Kuroda
    • 1
    • 3
  • Masahito Kawabori
    • 1
  • Kenji Hirata
    • 2
  • Tohru Shiga
    • 2
  • Daina Kashiwazaki
    • 1
  • Kiyohiro Houkin
    • 1
  • Nagara Tamaki
    • 2
  1. 1.Department of NeurosurgeryHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Department of Nuclear MedicineHokkaido University Graduate School of MedicineSapporoJapan
  3. 3.Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical ScienceUniversity of ToyamaToyamaJapan

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