Skip to main content

Advertisement

SpringerLink
Log in

Long-term patency of superficial temporal artery to middle cerebral artery bypass for cerebral atherosclerotic disease: factors determining the bypass patent

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Long-term patency of superficial temporal artery to middle cerebral artery (STA–MCA) bypass surgery for atherosclerotic disease and associated risk factors for loss of patency have rarely been discussed. We retrospectively analyzed long-term patency following STA–MCA bypass and evaluated various demographic and clinical factors to identify the ones predictive of postsurgical loss of patency using records of 84 revascularization procedures (58 patients, 45 males; mean age at surgery 63.6 years, range 31–78 years). Bypass patency was diagnosed based on magnetic resonance angiography or three-dimensional computed tomography. The mean follow-up period was 24.7 months (range 6–63 months). Decreased bypass patency was observed in 4 of 58 patients (6.9 %) who collectively underwent 6 bypasses (7.1 %) of 84. All cases of decreased bypass patency were first detected within 6 months of surgery. Bypass patency was not correlated with age, sex, number of anastomoses, postoperative cerebral infarction, or control of postoperative diabetes mellitus. We found a significant association of bypass patency with hyperperfusion (p = 0.01) and postoperative smoking (p = 0.0036). Furthermore, we found a significant association of hyperperfusion with STA diameter (p < 0.0001), location of anastomosis (p = 0.075), and preoperative cerebral blood flow (p = 0.0399). In our retrospective study, hyperperfusion and smoking after surgery may be risk factors for decreased bypass patency in cerebral atherosclerotic disease patients. Careful monitoring of patency to prevent hyperperfusion and cessation of smoking are recommended, particularly within 6 months of the surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

BBB :

breakdown of the blood–brain barrier

CBF :

cerebral blood flow

DWI :

MRI diffusion-weighted magnetic resonance angiography

ET :

endothelin

IMP :

SPECT N-isopropyl (123 I)-p-isodoamphetamine single-photon emission computed tomography

MRA :

magnetic resonance angiography

NO :

nitric oxide

STA–MCA :

superficial temporal artery to middle cerebral artery

3D :

CTA three-dimensional computed tomography

ROS :

reactive oxygen species

References

  1. (1985) Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. The EC/IC Bypass Study Group. N Engl J Med 313:1191–1200

  2. Amin-Hanjani S, Singh A, Rifai H et al (2013) Combined direct and indirect bypass for moyamoya: quantitative assessment of direct bypass flow over time. Neurosurgery 73:962–967, discussion 967–968

    Article  PubMed  Google Scholar 

  3. Arnson Y, Shoenfeld Y, Amital H (2010) Effects of tobacco smoke on immunity, inflammation and autoimmunity. J Autoimmun 34:J258–J265

    Article  CAS  PubMed  Google Scholar 

  4. Bremmer JP, Verweij BH, Klijn CJ, van der Zwan A, Kappelle LJ, Tulleken CA (2009) Predictors of patency of excimer laser-assisted nonocclusive extracranial-to-intracranial bypasses. J Neurosurg 110:887–895

    Article  PubMed  Google Scholar 

  5. Carlson AP, Yonas H, Chang YF, Nemoto EM (2011) Failure of cerebral hemodynamic selection in general or of specific positron emission tomography methodology?: Carotid Occlusion Surgery Study (COSS). Stroke 42:3637–3639

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chalouhi N, Ali MS, Starke RM et al (2012) Cigarette smoke and inflammation: role in cerebral aneurysm formation and rupture. Mediat Inflamm 2012:271582

    Article  Google Scholar 

  7. Fujimura M, Niizuma K, Inoue T et al (2014) Minocycline prevents focal neurological deterioration due to cerebral hyperperfusion after extracranial-intracranial bypass for moyamoya disease. Neurosurgery 74:163–170, discussion 170

    Article  PubMed  Google Scholar 

  8. Hossain M, Sathe T, Fazio V et al (2009) Tobacco smoke: a critical etiological factor for vascular impairment at the blood–brain barrier. Brain Res 1287:192–205

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Ivens S, Gabriel S, Greenberg G, Friedman A, Shelef I (2010) Blood–brain barrier breakdown as a novel mechanism underlying cerebral hyperperfusion syndrome. J Neurol 257:615–620

    Article  PubMed  Google Scholar 

  10. Kaku Y, Iihara K, Nakajima N et al (2012) Cerebral blood flow and metabolism of hyperperfusion after cerebral revascularization in patients with moyamoya disease. J Cereb Blood Flow Metab 32:2066–2075

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kim JH, Im KC, Kim JS et al (2007) Ictal hyperperfusion patterns in relation to ictal scalp EEG patterns in patients with unilateral hippocampal sclerosis: a SPECT study. Epilepsia 48:270–277

    Article  PubMed  Google Scholar 

  12. Madden JA (2012) Role of the vascular endothelium and plaque in acute ischemic stroke. Neurology 79:S58–S62

    Article  CAS  PubMed  Google Scholar 

  13. Matano F, Murai Y, Tateyama K et al (2013) Perioperative complications of superficial temporal artery to middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms. Clin Neurol Neurosurg 115:718–724

    Article  PubMed  Google Scholar 

  14. Mendelowitsch A, Taussky P, Rem JA, Gratzl O (2004) Clinical outcome of standard extracranial-intracranial bypass surgery in patients with symptomatic atherosclerotic occlusion of the internal carotid artery. Acta Neurochir (Wien) 146:95–101

    Article  CAS  Google Scholar 

  15. Mizumura S, Nakagawara J, Takahashi M et al (2004) Three-dimensional display in staging hemodynamic brain ischemia for JET study: objective evaluation using SEE analysis and 3D-SSP display. Ann Nucl Med 18:13–21

    Article  PubMed  Google Scholar 

  16. Murai Y, Mizunari T, Takagi R et al (2013) Analysis of ischemic cerebral lesions using 3.0-T diffusion-weighted imaging and magnetic resonance angiography after revascularization surgery for ischemic disease. Clin Neurol Neurosurg 115:1063–1070

    Article  PubMed  Google Scholar 

  17. Najjar S, Pearlman DM, Devinsky O, Najjar A, Zagzag D (2013) Neurovascular unit dysfunction with blood–brain barrier hyperpermeability contributes to major depressive disorder: a review of clinical and experimental evidence. J Neuroinflammation 10:142

    PubMed  PubMed Central  Google Scholar 

  18. Ogasawara K, Inoue T, Kobayashi M, Endo H, Fukuda T, Ogawa A (2004) Pretreatment with the free radical scavenger edaravone prevents cerebral hyperperfusion after carotid endarterectomy. Neurosurgery 55:1060–1067

    Article  PubMed  Google Scholar 

  19. Ogasawara K, Ogawa A (2006) JET study (Japanese EC-IC Bypass Trial). Nihon Rinsho 64(Suppl 7):524–527

    PubMed  Google Scholar 

  20. Okada Y, Shima T, Nishida M, Yamane K, Yamada T, Yamanaka C (1998) 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

    Article  CAS  PubMed  Google Scholar 

  21. Sakaki T, Tsujimoto S, Nishitani M, Ishida Y, Morimoto T (1992) Perfusion pressure breakthrough threshold of cerebral autoregulation in the chronically ischemic brain: an experimental study in cats. J Neurosurg 76:478–485

    Article  CAS  PubMed  Google Scholar 

  22. Schubert GA, Biermann P, Weiss C, et al. (2013) Risk profile in extracranial/intracranial bypass surgery-the role of antiplatelet agents, disease pathology, and surgical technique in 168 direct revascularization procedures. World Neurosurg

  23. Tomkins O, Kaufer D, Korn A et al (2001) Frequent blood–brain barrier disruption in the human cerebral cortex. Cell Mol Neurobiol 21:675–691

    Article  CAS  PubMed  Google Scholar 

  24. Yoshida K, Ogasawara K, Saura H, et al. (2015) Post-carotid endarterectomy changes in cerebral glucose metabolism on F-fluorodeoxyglucose positron emission tomography associated with postoperative improvement or impairment in cognitive function. J Neurosurg:1–9

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Fumihiro Matano, Yasuo Murai, Akira Teramoto & Akio Morita

  2. Department of Neurological Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan

    Kojiro Tateyama

  3. Department of Neurological Surgery, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan

    Tomonori Tamaki

  4. Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan

    Takayuki Mizunari

  5. Department of Neurological Surgery, Teishinkai Hospital, Sapporo, Japan

    Hideoshi Matsukawa

Authors
  1. Fumihiro Matano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuo Murai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kojiro Tateyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tomonori Tamaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takayuki Mizunari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hideoshi Matsukawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akira Teramoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Akio Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fumihiro Matano.

Ethics declarations

Conflict of interest

None of the authors have any conflicts of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matano, F., Murai, Y., Tateyama, K. et al. Long-term patency of superficial temporal artery to middle cerebral artery bypass for cerebral atherosclerotic disease: factors determining the bypass patent. Neurosurg Rev 39, 655–661 (2016). https://doi.org/10.1007/s10143-016-0736-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-016-0736-5

Keywords

Search

Navigation