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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 24:886-891, May 2003
© 2003 American Society of Neuroradiology

BRAIN

Ultrasonographically Predicting the Extent of Collateral Flow through Superficial Temporal Artery-to-Middle Cerebral Artery Anastomosis

Shuji Arakawa^a, Masahiro Kamouchi^a,c, Yasushi Okada^a, Kazuhiro Kishikawa^a, Tsuyoshi Omae^a, Tooru Inoue^b, Setsuro Ibayashi^c and Masatoshi Fujishima^c

^a Department of Cerebrovascular Disease (S.A., M.K., Y.O., K.K., T.O.), Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan
^b Department of Neurosurgery (T.I.), Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan
^c Department of Medicine and Clinical Science (M.K., S.I., M.F.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Address reprint requests to Shuji Arakawa, MD, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan

BACKGROUND AND PURPOSE: This study was performed to elucidate whether the extent of bypass flow through superficial temporal artery-to-middle cerebral artery (STA-MCA) anastomosis could be indirectly estimated by measuring the blood flow velocity in the superficial temporal artery (STA) by using duplex ultrasonography.

METHODS: We analyzed 29 patients (31 sides) who underwent STA-MCA bypass surgery for occlusive cerebrovascular disease (28 sides) or unclippable cerebral aneurysm that required therapeutic occlusion of the internal carotid artery (three sides). The flow velocities of the STA were measured by using ultrasonography. For patients who underwent the surgery unilaterally, the flow velocity ratios of the operated side to the contralateral side for the individual arteries were calculated. The correlation between these flow velocity parameters and the extent of bypass flow, which was graded based on the findings of cerebral angiography, was investigated.

RESULTS: Both the affected STA flow velocity and the STA flow velocity ratio, particularly those in the end diastole, increased in patients with more extensive bypass flow. In patients with extensive, moderate, and poor bypass flow, the end diastolic flow velocities of the operated STA were 27.4 ± 8.8, 23.0 ± 7.8, and 13.5 ± 7.5 cm/s, respectively and the end diastolic flow velocity ratios of the STA were 3.4 ± 0.8, 2.1 ± 0.5 and 1.3 ± 0.4, respectively. The pulsatility index and resistance index of the affected STA were significantly lower in the patients with more extensive bypass flow. The optimal threshold value of the end diastolic flow velocity ratio of STA for the group with extensive bypass flow was 2.75, whereas that for the group with poor bypass flow was 1.60. With the obtained values, the sensitivity and specificity were 87.5% and 93.9% for the group with extensive bypass flow and 95.2% and 95.0% for the group with poor bypass flow, respectively.

CONCLUSION: The blood flow velocity in the operated STA seems to be a highly sensitive parameter for predicting the extent of bypass flow in patients undergoing STA-MCA anastomosis.