より効果的なSTA-MCA bypass術 : data evidenceによるstandard化  [in Japanese] Practically Most Effective Method of the STA-MCA Anastomosis to Cerebral Misery Perfusion  [in Japanese]

The efficacy of a superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis for patients with poor cerebral blood flow (CBF) and severe decrease of cerebral vascular reserve (CVR) has been recently proved in a Japanese EC-IC bypass trial study. However, we have little clinical knowledge or evidence regarding how to increase CBF or how to evade ischemic risk when performing this surgery. We examined the size and the number of the donor arteries and the location of the recipient artery to retrospectively determine the difference of increase on CBF and CVR by their methods. The objects were 34 patients with preoperative misery perfusion of low rCBF and poor rCVR. Both were evaluated preoperatively, immediately after operation, and at least 3 weeks after operation with N-isopropyl-p-[^<123>I] iodoamphetamine. The patients were divided into groups based on the number of the donor arteries or the location of the recipient artery and statistically compared. Postoperative rCVRs increased dramatically from preoperative rCVRs, compared with a small increase of rCBF. Single bypass showed an increase of rCBF and rCVR similar to that of double bypass. Selection of the recipient artery in the sylvian fissure showed significantly more increase of rCVR. Double bypass with selection of the larger recipient artery was most effective for improving misery perfusion.