Abstract 74: Improvement in Cerebral Hemodynamic Parameters and Outcome after Superficial Temporal Artery- Middle Cerebral Artery Bypass in Patients with Severe Steno-occlusive Disease of Intracranial Carotid and Middle Cerebral Artery

Background and Objective: Older and the recent extracranial-intracranial (EC/IC) bypass trials for symptomatic carotid occlusion failed to demonstrate reduction in stroke recurrence. However, role of superficial temporal artery-middle cerebral artery (STA-MCA) bypass in patients with symptomatic intracranial steno-occlusive disease has been evaluated scarcely. We evaluated serial changes in various cerebral hemodynamic parameters in patients with severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) and impaired cerebral vasodilatory reserve (CVR), treated with STA-MCA bypass surgery or medical treatment. Methods: Patients with severe steno-occlusive disease of intracranial ICA or MCA underwent transcranial Doppler (TCD) ultrasonography and CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-challenged hexamethylpropyleneamine-oxime single-photon emission computed tomography (HMPAO-SPECT). STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. All patients underwent TCD and SPECT at 4±1 months and followed-up for cerebral ischemic events. Results: A total of 112patients (73males, mean age 56yrs; range 23-78yrs) were included. HMPAO-SPECT demonstrated impaired CVR in 77 (69%) patients. Of them, 46 underwent STA-MCA bypass while 31 received best medical treatment. TCD and acetazolamide-challenged HMPAO-SPECT repeated 4±1months showed significant improvement in STA-MCA bypass group. During follow-up (mean 34months; range 18-39months), only 6/46 (13%) patients in bypass group developed cerebral ischemic events as compared to 14/31 (45%) cases on medical therapy (absolute risk-reduction 32%, p=0.008). Conclusion: STA-MCA bypass surgery in carefully selected patients with symptomatic severe intracranial steno-occlusive disease results in significant improvement in hemodynamic parameters and reduction in stroke recurrence.

Download Full-text

Abstract WP161: Improvement in Cerebral Hemodynamic Parameters and outcomes after Superficial Temporal Artery- Middle Cerebral Artery Bypass in Patients with Severe Steno-occlusive Disease of Intracranial Carotid and Middle Cerebral Artery

Stroke ◽

10.1161/str.44.suppl_1.awp161 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

leonard yeo ◽

Aftab Ahmad ◽

teo ke jia ◽

sein lwin ◽

yeo T Tsai ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Bypass Surgery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Occlusive Disease ◽

Stroke Recurrence ◽

Hemodynamic Parameters ◽

Bypass Group ◽

Hmpao Spect

Background and Objective —Older as well as the recent extracranial-intracranial (EC/IC) bypass trial in patients with symptomatic carotid occlusion failed to demonstrate reduction in stroke recurrence. However, the role of superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in patients with symptomatic intracranial steno-occlusive disease has been evaluated scarcely. We evaluated the changes in various hemodynamic parameters in patients with severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) who underwent STA-MCA bypass surgery for impaired cerebral vasodilatory reserve (CVR). Methods —Patients with severe steno-occlusive disease of intracranial ICA or MCA underwent transcranial Doppler (TCD) ultrasonography and CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-challenged hexamethylpropyleneamine oxime single-photon emission computed tomography (HMPAO-SPECT). STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. TCD and SPECT were repeated in all patients at 4±1 months and they were followed-up for cerebral ischemic events. Results —112 patients (73males, mean age 56yrs; range 23-78yrs) fulfilled our inclusion criteria. HMPAO-SPECT demonstrated impaired CVR in 77 (69%) patients. Forty-six of them underwent STA-MCA bypass while 31 received best medical treatment. TCD and acetazolamide-challenged HMPAO-SPECT repeated 4±1 months after surgery showed significant improvement in STA-MCA bypass group. During follow-up (mean 24 months; range 4 to 33months), only 6/46 (13%) patients in bypass group developed cerebral ischemic events as compared to14/31 (45%) cases on medical therapy (absolute risk reduction 32%, p=0.008). Conclusion —STA-MCA bypass surgery in carefully selected patients with symptomatic severe intracranial steno-occlusive disease results in significant improvement in hemodynamic parameters and reduction in stroke recurrence

Download Full-text

Abstract T MP26: Role of 99tc-hmpao Spect in the Assessment of Cerebral Hemodynamic Parameters After Superficial Temporal Artery- Middle Cerebral Artery Bypass in Patients With Severe Steno-Occlusive Disease of Intracranial Carotid and Middle Cerebral Artery

Stroke ◽

10.1161/str.45.suppl_1.tmp26 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Amit Batra ◽

Arvind K Sinha ◽

Leonard L Yeo ◽

Rahul Rathakrishnan ◽

Prakash Paliwal ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Bypass Surgery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Occlusive Disease ◽

Hemodynamic Parameters ◽

Bypass Group ◽

Hmpao Spect ◽

Cerebral Ischemic

Background and Objective: Although superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery in patients with symptomatic carotid occlusion failed to demonstrate any benefit, its role in symptomatic intracranial steno-occlusive disease has been evaluated scarcely. We evaluated changes in hemodynamic parameters in patients with severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) who underwent STA-MCA bypass for impaired cerebral vasodilatory reserve (CVR). Methods: Patients with severe steno-occlusive disease of intracranial ICA or MCA underwent transcranial Doppler (TCD) evaluation and CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-challenged 99Tc-HMPAO-SPECT. STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. TCD and SPECT were repeated in all patients at 4±1 months and they were followed-up for cerebral ischemic events. Results: Of the 126 patients (80 male, mean age 56yrs; range 23-78yrs) that fulfilled our inclusion criteria, 84 (67%) showed impaired CVR HMPAO-SPECT. Fifty (60%) of them underwent STA-MCA bypass while 34(40%) received best medical treatment. TCD and acetazolamide-challenged HMPAO-SPECT repeated 4±1 months after surgery showed significant improvement in STA-MCA bypass group. TCD BHI improved from a median (IQR) of -0.05 to 1.1 (p<0.001). Compared to 98% patients with impaired CVR on pre-operative SPECT, only 20% showed abnormal results on post-operative imaging (p<0.001). During follow-up (mean 35 months; range 8 to 49months), only 6/50 (12%) patients in bypass group developed cerebral ischemic events as compared to15/34 (44%) cases on medical therapy (absolute risk reduction 32%, p=0.006). Conclusion: 99Tc-HMPAO SPECT with acetazolamide challenge is a reliable tool for the assessment of cerebral vasodilatory reserve in patients with severe steno-occlusive disease of intracranial ICA or MCA. STA-MCA bypass surgery in carefully selected patients results in significant improvement in hemodynamic parameters and reduction in stroke recurrence.

Download Full-text

Improvement in cerebral hemodynamic parameters and outcomes after superficial temporal artery-middle cerebral artery bypass in patients with severe stenoocclusive disease of the intracranial internal carotid or middle cerebral arteries

Journal of Neurosurgery ◽

10.3171/2014.11.jns141553 ◽

2015 ◽

Vol 123 (3) ◽

pp. 662-669 ◽

Cited By ~ 25

Author(s):

Shiong Wen Low ◽

Kejia Teo ◽

Sein Lwin ◽

Leonard L. L. Yeo ◽

Prakash R. Paliwal ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Bypass Surgery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Stroke Recurrence ◽

Hemodynamic Parameters ◽

Bypass Group ◽

Hmpao Spect ◽

Cerebral Ischemic

OBJECT Both the older and the recent extracranial-intracranial (EC-IC) bypass trials for symptomatic carotid occlusion failed to demonstrate a reduction in stroke recurrence. However, the role of superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in patients with symptomatic intracranial stenoocclusive disease has been rarely evaluated. The authors evaluated serial changes in various cerebral hemodynamic parameters in patients with severe stenoocclusive disease of the intracranial internal carotid artery (ICA) or middle cerebral artery (MCA) and impaired cerebral vasodilatory reserve (CVR), treated by STA-MCA bypass surgery or medical treatment. METHODS Patients with severe stenoocclusive disease of the intracranial ICA or MCA underwent transcranial Doppler (TCD) ultrasonography and CVR assessment using the breath-holding index (BHI). Patients with impaired BHI (< 0.69) were further evaluated with acetazolamide-challenge technitium-99m hexamethylpropyleneamine oxime (99mTc HMPAO) SPECT. STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. All patients underwent TCD and SPECT at 4 ± 1 months and were followed up for cerebral ischemic events. RESULTS A total of 112 patients were included. This total included 73 men, and the mean age of the entire study population was 56 years (range 23–78 years). 99mTc HMPAO SPECT demonstrated impaired CVR in 77 patients (69%). Of these 77 patients, 46 underwent STA-MCA bypass while 31 received best medical treatment. TCD and acetazolamide-challenge 99mTc HMPAO SPECT repeated at 4 ± 1 months showed significant improvement in the STA-MCA bypass group. During a mean follow-up of 34 months (range 18–39 months), only 6 (13%) of 46 patients in the bypass group developed cerebral ischemic events, as compared with 14 (45%) of 31 patients receiving medical therapy (absolute risk reduction 32%, p = 0.008). CONCLUSIONS STA-MCA bypass surgery in carefully selected patients with symptomatic severe intracranial stenoocclusive disease of the intracranial ICA or MCA results in significant improvement in hemodynamic parameters and reduction in stroke recurrence.

Download Full-text

Abstract WMP110: Improvement in Cortical Versus Subcortical Perfusion After Superficial Temporal Artery- Middle Cerebral Artery (MCA) Bypass in Patients With Severe Stenosis of Intracranial Carotid and MCA

Stroke ◽

10.1161/str.47.suppl_1.wmp110 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Vijay K Sharma ◽

Nagarjun Bolem ◽

Ning Chow ◽

Lily Y Wong ◽

Hock-Luen Teoh ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Cerebral Perfusion ◽

Bypass Surgery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Occlusive Disease ◽

Hmpao Spect ◽

Subcortical Regions ◽

Cortical Regions

Background and Objective: The role of superficial temporal artery-middle cerebral artery (STA-MCA) bypass in patients with symptomatic intracranial steno-occlusive disease has been evaluated scarcely. We have recently reported the improvement in clinical and various cerebral hemodynamic parameters after STA-MCA bypass surgery for severe steno-occlusive disease of intracranial internal carotid (ICA) or middle cerebral artery (MCA) and impaired cerebral vasodilatory reserve (CVR). Using acetazolamide challenged hexamethylpropyleneamine-oxime single-photon emission computed tomography (HMPAO-SPECT), we evaluated the differential improvement in metabolic perfusion in cortical and subcortical structures after STA-MCA bypass surgery. Methods: Patients with severe steno-occlusive disease of intracranial ICA or MCA underwent transcranial Doppler (TCD) for CVR assessment using breath-holding index (BHI). Patients with impaired BHI (<0.69) were further evaluated with acetazolamide-challenged SPECT and STA-MCA bypass surgery was offered to patients with impaired CVR on SPECT. All patients underwent SPECT at 4±1 months. Using automated image analyzer, we evaluated differences in metabolic perfusion in cortical and subcortical regions. Results: Of the 126 patients (80 male, mean age 56yrs; range 23-78yrs) that fulfilled our inclusion criteria, 84 (67%) showed impaired CVR on SPECT. Fifty (60%) of them underwent STA-MCA bypass surgery. HMPAO-SPECT repeated 4±1 months after surgery showed significant improvement in all cases. Significantly better improvement (14.5%) in cerebral perfusion was noted in the cortical regions as compared to the subcortical regions (4.5%, p<0.005). Conclusion: STA-MCA bypass surgery in carefully selected patients with symptomatic severe intracranial steno-occlusive disease results in significant improvement in cerebral perfusion, especially in the cortical regions.

Download Full-text