Superficial temporal artery-to-middle cerebral artery side-to-side microvascular anastomosis using the in-situ intraluminal suturing technique.

Background: Superficial temporal artery (STA)-middle cerebral artery (MCA) side-to-side microvascular anastomosis can achieve the same clinical effects as traditional STA-MCA end-to-side anastomosis in extracranial-intracranial revascularization surgery, furthermore, STA-MCA side-to-side anastomosis has the lower risk of postoperative cerebral hyperperfusion syndrome (CHS) and the potential to recruit all scalp arteries as the donor sources via self-regulation. Therefore, STA-MCA side-to-side microvascular anastomosis seems to be a revascularization strategy superior to traditional STA-MCA end-to-side anastomosis. In this study, we presented seven cases in which a STA-MCA side-to-side microvascular anastomosis was performed with a 4-5 mm long arteriotomy using the in-situ intraluminal suturing technique.

Methods: Superficial temporal artery (STA)-middle cerebral artery (MCA) side-to-side anastomosis was performed in seven patients using the in-situ intraluminal suturing technique.

Results: The diameters of the recipient MCA and the donor STA were approximately 0.94 mm (range 0.8-1.4 mm) and 1.65 mm (range 1.4-2.0 mm), respectively, and the length of the arteriotomy was approximately 4.71 mm (range 4-5 mm). The MCA was temporarily occluded in approximately 25.00 min (range 20-29 min). 100% patency rates of the STA-MCA microvascular anastomosis were achieved in all patients. No obvious CHS was recorded. Intraoperative Indocyanine green videoangiography (ICG-VA) and postoperative digital subtraction angiography (DSA) demonstrated three different blood flow distribution patterns after the STA-MCA side-to-side anastomosis, the donor MCA received not only antegrade blood flow from the proximal preanastomotic STA but also retrograde blood flow from the distal postanastomotic STA in one case; the donor MCA received all the antegrade blood from the proximal STA without retrograde blood flow from the distal STA in two case; whereas, the recipient MCA territories received only partial antegrade blood flow from the proximal preanastomotic STA.

Conclusions: STA-MCA side-to-side microvascular anastomosis with a 4-5 mm long arteriotomy using the in situ intraluminal suturing technique is a safe and effective revascularization surgery, and the anastomosis can serve as a shunt for blood flow self-regulation.