Date Published: July 21, 2017
Publisher: JKL International LLC
Author(s): Xin Li, Zheng Huang, Ming-Xing Wu, Dong Zhang.
Superficial temporal artery-middle cerebral artery (STA-MCA) has been used for the treatment of occlusive cerebrovascular disease including moyamoya disease. The effect of STA-MCA bypass depends not only on the patency of anastomosis, but also on integrity and functional capacity of the donor artery. In the present prospective study, we investigated the effect of extensive stripping STA adventitia and fasciae on hemodynamic function in STA-MCA bypass of moyamoya disease patients. Twenty patients (n=8 in control group, n=12 in stripping group) of moyamoya disease were subjected to STA-MCA end-to-side direct anastomosis. Perfusion unit (PU) values of the cortex were measured and recorded using a Laser Doppler flowmetry (LDF) for 5 days. Computed tomography perfusion was performed to determine blood flow before and after bypass. No patient experienced significant neurologic deficits associated with neurosurgical complications. LDF demonstrated that adventitial stripping group had higher cerebral blood flow increase than control group. The adventitia stripping group tends to have higher rate of increased cerebral perfusion after bypass than non-stripping group. Furthermore, the ultrasound examination at 3 days after bypass demonstrated that the adventitial stripping group has a tendency of bigger STA and higher peak systolic velocity than control group. Our result suggests that stripping adventitia of STA improves hemodynamics of STA-MCA bypass in moyamoya disease.
STA-MCA bypass allows blood flow bypass proximal lesion of intracranial vasculature and has been used for occlusive cerebrovascular disease for almost half century . In 1980s, STA-MCA bypass fell from favor after an international randomized trial failed to demonstrate any benefit of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke . In the last two decades, the modern technological advancements such as LDF [4, 5, 8], infrared camera thermography , and quantitative MRA  for hemodynamic measurement have allowed us to reappraise the effect of STA-MCA bypasses on cerebrovascular disease [10, 11]. There is increasing evidence indicated that STA-MCA bypasses not only improve neurological function but also prevent stroke recurrence in subgroup patients of cerebrovascular disease [12-18].