STA-MCA/STA-PCA Bypass Using Short Interposition Vein Graft

Abstract

Background and aims: Superficial temporal artery (STA) is the mainstay of donor vessels for extra-intracranial bypass (EC-IC bypass) in cerebral revascularization. However, the typically used STA frontal or parietal branch is not always adequate in its flow-carrying capacity. In the present study, we provide an update on an alternative strategy: the use of the STA main trunk as a donor vessel, with a short vein interposition graft. Methods: Seven patients in whom the STA main trunk was used as a donor site for anastomosis of a short interposition vein graft were included. The grafts were implanted into the M2 of the middle cerebral artery for adjunctive treatment of IC anterior wall blood-blister aneurysms in two patients, for revascularization of an internal carotid artery occlusion in one patient, into the P2/3 of the posterior cerebral artery (PCA) for adjunct treatment of complex PCA aneurysms in three patients and into the P3 of PCA for adjunct treatment of basilar artery (BA) trunk giant aneurysm in one patient. Results: All the bypasses were patent. Intraoperative flow measurements confirmed a moderate flow-carrying capacity of the STA main trunk-interposition short vein graft (20-50 ml; mean 43 ml/min). Conclusion: The STA main trunk has a larger diameter than the distal branch; therefore, it would be expected to have a significantly higher flow capacity than its branches. STA main trunk to proximal MCA/PCA bypass using short interposition vein grafts can provide sufficient blood flow, and may be a reasonable alternative to ECA to MCA/PCA bypass using long vein grafts.