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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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

STA-MCA anastomosis Acetazolamide Oxygen extraction fraction Bypass surgery 

Notes

Conflicts of interest

None.

Disclosure of funding

None.

Financial support and industry affiliations

None.

References

  1. 1.
    Amin-Hanjani S, Barker FG 2nd, Charbel FT, Connolly ES Jr, Morcos JJ, Thompson BG (2012) Extracranial-intracranial bypass for stroke-is this the end of the line or a bump in the road? Neurosurgery 71:557–561PubMedCrossRefGoogle Scholar
  2. 2.
    Chida K, Ogasawara K, Kuroda H, Aso K, Kobayashi M, Fujiwara S, Yoshida K, Terasaki K, Ogawa A (2011) Central benzodiazepine receptor binding potential and CBF images on SPECT correlate with oxygen extraction fraction images on PET in the cerebral cortex with unilateral major cerebral artery occlusive disease. J Nucl Med 52:511–518PubMedCrossRefGoogle Scholar
  3. 3.
    Derdeyn CP, Yundt KD, Videen TO, Carpenter DA, Grubb RL Jr, Powers WJ (1998) Increased oxygen extraction fraction is associated with prior ischemic events in patients with carotid occlusion. Stroke 29:754–758PubMedCrossRefGoogle Scholar
  4. 4.
    Duckworth EA, Rao VY, Patel AJ (2013) Double barrel bypass for cerebral ischemia: technique, rationale, and preliminary experience with 10 consecutive cases. Neurosurgery 73(1 Suppl Operative):ons30–38Google Scholar
  5. 5.
    Grubb RL Jr, Derdeyn CP, Fritsch SM, Carpenter DA, Yundt KD, Videen TO, Spitznagel EL, Powers WJ (1998) Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA 280:1055–1060PubMedCrossRefGoogle Scholar
  6. 6.
    Grubb RL Jr, Powers WJ, Clarke WR, Videen TO, Adams HP Jr, Derdeyn CP (2013) Surgical results of the carotid occlusion surgery study. J Neurosurg 118:25–33PubMedCrossRefGoogle Scholar
  7. 7.
    Hokari M, Kuroda S, Shiga T, Nakayama N, Tamaki N, Iwasaki Y (2008) Combination of a mean transit time measurement with an acetazolamide test increases predictive power to identify elevated oxygen extraction fraction in occlusive carotid artery diseases. J Nucl Med 49:1922–1927PubMedCrossRefGoogle Scholar
  8. 8.
    Hokari M, Kuroda S, Shiga T, Nakayama N, Tamaki N, Iwasaki Y (2008) Impact of oxygen extraction fraction on long-term prognosis in patients with reduced blood flow and vasoreactivity because of occlusive carotid artery disease. Surg Neurol 71:532–539PubMedCrossRefGoogle Scholar
  9. 9.
    Kuroda S, Houkin K, Kamiyama H, Mitsumori K, Iwasaki Y, Abe H (2001) Long-term prognosis of medically treated patients with internal carotid or middle cerebral artery occlusion: can acetazolamide test predict it? Stroke 32:2110–2116PubMedCrossRefGoogle Scholar
  10. 10.
    Kuroda S, Shiga T, Houkin K, Ishikawa T, Katoh C, Tamaki N, Iwasaki Y (2006) Cerebral oxygen metabolism and neuronal integrity in patients with impaired vasoreactivity attributable to occlusive carotid artery disease. Stroke 37:393–398PubMedCrossRefGoogle Scholar
  11. 11.
    Kuroda S, Shiga T, Ishikawa T, Houkin K, Narita T, Katoh C, Tamaki N, Iwasaki Y (2004) Reduced blood flow and preserved vasoreactivity characterize oxygen hypometabolism due to incomplete infarction in occlusive carotid artery diseases. J Nucl Med 45:943–949PubMedGoogle Scholar
  12. 12.
    Nemoto EM, Yonas H, Kuwabara H, Pindzola RR, Sashin D, Meltzer CC, Price JC, Chang Y, Johnson DW (2004) Identification of hemodynamic compromise by cerebrovascular reserve and oxygen extraction fraction in occlusive vascular disease. J Cereb Blood Flow Metab 24:1081–1089PubMedCrossRefGoogle Scholar
  13. 13.
    Ogasawara K, Ogawa A (2006) Japanese EC-IC bypass trial. Nippon Rinsho 64(7):524–527PubMedGoogle Scholar
  14. 14.
    Ogasawara K, Ogawa A, Yoshimoto T (2002) Cerebrovascular reactivity to acetazolamide and outcome in patients with symptomatic internal carotid or middle cerebral artery occlusion: a xenon-133 single-photon emission computed tomography study. Stroke 33:1857–1862PubMedCrossRefGoogle Scholar
  15. 15.
    Powers WJ (1991) Cerebral hemodynamics in ischemic cerebrovascular disease. Ann Neurol 29:231–240PubMedCrossRefGoogle Scholar
  16. 16.
    Powers WJ, Clarke WR, Adams HP Jr, Derdeyn CP, Grubb RL Jr (2012) Commentary: extracranial-intracranial bypass for stroke in 2012: response to the critique of the carotid occlusion surgery study “It was deja vu all over again”. Neurosurgery 71:E772–E776PubMedCrossRefGoogle Scholar
  17. 17.
    Powers WJ, Clarke WR, Grubb RL Jr, Videen TO, Adams HP Jr, Derdeyn CP (2011) Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA 306:1983–1992PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Rodriguez-Hernandez A, Josephson SA, Lawton MT (2012) Bypass surgery for the prevention of ischemic stroke: current indications and techniques. Neurocir (Astur) 23:5–14Google Scholar
  19. 19.
    Yamauchi H, Fukuyama H, Nagahama Y, Nabatame H, Ueno M, Nishizawa S, Konishi J, Shio H (1999) Significance of increased oxygen extraction fraction in five-year prognosis of major cerebral arterial occlusive diseases. J Nucl Med 40:1992–1998PubMedGoogle Scholar
  20. 20.
    Yamauchi H, Okazawa H, Kishibe Y, Sugimoto K, Takahashi M (2004) Oxygen extraction fraction and acetazolamide reactivity in symptomatic carotid artery disease. J Neurol Neurosurg Psychiatry 75:33–37PubMedCrossRefGoogle Scholar

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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