Effect of newly developed scissors-attached micro-forceps on the recipient clamp time and occurrence of anastomotic site infarction after bypass surgery for moyamoya disease

Munetaka Yomo; Ryuhei Kitai; Hiroyuki Tada; Makoto Isozaki; Yoshifumi Higashino; Ken Matsuda; Takahiro Yamauchi; Ayumi Akazawa; Satoshi Kawajri; Mizuki Oiwa; Shintaro Yamada; Tadahiro Tsubota; Akifumi Watanabe; Hidehiko Okazawa; Yasushi Kiyono; Hidetaka Arishma; Kenichiro Kikuta

doi:10.3389/fneur.2023.1269400

Effect of newly developed scissors-attached micro-forceps on the recipient clamp time and occurrence of anastomotic site infarction after bypass surgery for moyamoya disease

Front Neurol. 2023 Oct 6:14:1269400. doi: 10.3389/fneur.2023.1269400. eCollection 2023.

Authors

Munetaka Yomo¹, Ryuhei Kitai², Hiroyuki Tada³, Makoto Isozaki¹, Yoshifumi Higashino¹, Ken Matsuda¹, Takahiro Yamauchi¹, Ayumi Akazawa¹, Satoshi Kawajri¹, Mizuki Oiwa¹, Shintaro Yamada¹, Tadahiro Tsubota¹, Akifumi Watanabe¹, Hidehiko Okazawa⁴, Yasushi Kiyono⁴, Hidetaka Arishma¹, Kenichiro Kikuta^{1

5}

Affiliations

¹ Division of Medicine, Department of Neurosurgery, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
² Department of Neurosurgery, Kaga Medical Center, Kaga, Japan.
³ Technology Development Section, Charmant Co., Ltd., Sabae, Japan.
⁴ Biomedical Imaging Research Center, University of Fukui, Fukui, Japan.
⁵ Life Science Innovation Center, University of Fukui, Fukui, Japan.

Abstract

Introduction: This study aimed to examine the effect of newly developed scissors-attached micro-forceps in superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD).

Materials and methods: Of 179 consecutive STA-MCA anastomoses on 95 hemispheres of 71 MMD patients at the University of Fukui Hospital between 2009 and 2023, 49 anastomoses on 26 hemispheres of 21 patients were enrolled in this retrospective cohort clinical trial intraoperative indocyanine green video-angiography did not demonstrate bypass patency in three anastomoses in two patients who were excluded. Twenty-one anastomosis in 19 hemispheres of 16 patients were performed using the conventional micro-forceps (conventional group, CG), and 25 anastomoses in 22 hemispheres of 19 patients were performed using scissors-attached micro-forceps (scissors group, SG). A small infarction near the anastomotic site detected using postoperative diffusion-weighted imaging was defined as anastomotic site infarction (ASI). Factors affecting the occurrence of ASI were examined by univariate, logistic regression, and receiver operating curve (ROC) analysis.

Results: There were no significant differences in clinical parameters such as age, sex, number of sacrificed branches, number of sacrificed large branches, and number of sutures between the CG and SG. However, the clamp time and occurrence of ASI were significantly lower in the SG than in the CG. Logistic regression analysis revealed that the clamp time was the only significant factor predicting the occurrence of ASI. A receiver operating curve analysis also revealed that the clamp time significantly predicted the occurrence of ASI (area under the curve, 0.875; cutoff value, 33.2 min).

Conclusion: The newly developed scissors-attached micro-forceps could significantly reduce the clamp time and occurrence of ASI in STA-MCA anastomosis for MMD.

Keywords: STA-MCA anastomosis; anastomotic site; clamp time; ischemia; micro-forceps; moyamoya disease.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by a Grant-in-Aid for Scientific Research by the Japan Society for the Promotion of Science (JSPS) (No. 20K09344).