Is STA really a low-flow graft? A quantitative ultrasonographic study of the flow of STA for cerebral revascularization in MMD patients

Yunyu Wen; Yanxia Gou; Baoping Wang; Zhibin Wang; Siyuan Chen; Shichao Zhang; Guozhong Zhang; Mingzhou Li; Wenfeng Feng; Songtao Qi; Gang Wang

doi:10.1111/cns.14197

Is STA really a low-flow graft? A quantitative ultrasonographic study of the flow of STA for cerebral revascularization in MMD patients

CNS Neurosci Ther. 2023 Sep;29(9):2572-2582. doi: 10.1111/cns.14197. Epub 2023 Apr 1.

Authors

Yunyu Wen^{1

2}, Yanxia Gou³, Baoping Wang⁴, Zhibin Wang^{1

2}, Siyuan Chen^{1

2}, Shichao Zhang^{1

2}, Guozhong Zhang^{1

2}, Mingzhou Li^{1

2}, Wenfeng Feng^{1

2}, Songtao Qi^{1

2}, Gang Wang^{1

2}

Affiliations

¹ Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
² Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
³ Department of Stomatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
⁴ Department of Ultrasound, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.

Abstract

Objective: Direct revascularization remains an important tool in the treatment of patients with Moyamoya disease (MMD). The superficial temporal artery (STA) is the most commonly used donor vessel for direct bypass, and an STA graft has traditionally been considered a low-flow graft for flow augmentation. This study aimed to quantitatively evaluate the blood flow of the STA after direct revascularization.

Methods: All direct revascularization procedures performed between 2018 and 2021 by one experienced neurosurgeon were screened. Quantitative ultrasound was used to measure the flow data of the patient's bilateral parietal branch of the STA(STA-PB), the bilateral frontal branch of the STA(STA-FB), and the left radial artery. Data on the patients' basic information, Suzuki grade, Matsushima type, anastomosis type, and blood biochemical parameters were collected and analyzed using univariate and multivariate models. An MBC Scale scoring system was proposed to evaluate the recipient artery network of the middle cerebral artery (MCA) tree. The relationship between MBC Scale score and STA graft flow was statistically analyzed.

Results: In total, 81 patients (43 males and 38 females) successfully underwent STA-MCA bypass and were included in this study. The mean flow rates in the STA-PB graft on 1 day preoperatively, 1 day postoperatively, 7 days postoperatively, and >6 months postoperatively (long-term) were 10.81, 116.74, 118.44, and 56.20 mL/min respectively. Intraoperative graft patency was confirmed in all patients. Comparing the preoperative and all postoperative time points, the STA-PB flow rates were statistically significant (p < 0.001). The MCA-C score was significantly associated with postoperative flow rate on day 1 (p = 0.007).

Conclusion: The STA is a useful donor artery for direct revascularization inpatients with MMD and can provide sufficient blood supply to the ischemic cerebral territory.

Keywords: Moyamoya disease; STA-MCA bypass; cerebrovascular disease; quantitative ultrasonography; stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cerebral Revascularization* / adverse effects
Cerebral Revascularization* / methods
Female
Humans
Male
Middle Cerebral Artery / diagnostic imaging
Middle Cerebral Artery / physiology
Middle Cerebral Artery / surgery
Moyamoya Disease* / diagnostic imaging
Moyamoya Disease* / surgery
Temporal Arteries / diagnostic imaging
Temporal Arteries / surgery

Supplementary concepts

Moyamoya disease 1