Ultrasonographically Predicting the Extent of Collateral Flow through Superficial Temporal Artery-to-Middle Cerebral Artery Anastomosis
Shuji Arakawaa,
Masahiro Kamouchia,c,
Yasushi Okadaa,
Kazuhiro Kishikawaa,
Tsuyoshi Omaea,
Tooru Inoueb,
Setsuro Ibayashic and
Masatoshi Fujishimac
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
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FIG 1. Postoperative digital subtraction angiograms and changes in pulsed Doppler ultrasonographic images of STA.
A, Postoperative digital subtraction angiograms. Pattern of collateral circulation through bypass was graded based on the findings of a postoperative angiogram of the external carotid artery.
B, Preoperative images of affected side.
C, Preoperative images of nonaffected side.
D, Postoperative images of affected side.
E, Postoperative images of nonaffected side.
Doppler wave forms of STA in a patient with extensive (top), moderate (middle), and poor (bottom) bypass flow are also shown. The vertical axis represents the flow velocity (in cm/s). Note that the postoperative EDV of the affected STA increased in patients with more extensive bypass flow. The postoperative EDV ratios of the anastomosed STA to the contralateral one was 3.9 (top), 2.1 (middle), and 1.5 (bottom), respectively.
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FIG 2. EDV of anastomosed STA after STA-MCA bypass surgery. Patients were divided into three subgroups according to the extent of bypass flow based on angiograms of the external carotid artery. Values of EDV were compared among groups. EDV was significantly higher in patients with more extensive bypass flow. a, P < .0001 versus control group; b, P < .01 versus poor group.
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FIG 3. Ratios of EDV of affected STA to contralateral STA after STA-MCA bypass surgery in each group. Ratio of EDV was significantly higher in patients with more extensive bypass flow, and significant differences were observed between each group, except between the poor and control groups. a, P < .0001 versus control group; b, P < .0001 versus poor group. c, P < .0001 versus moderate group; bb, P < .05 versus poor group.
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FIG 4. Sensitivity-specificity curve based on EDV ratio of affected STA to contralateral STA. Optimal threshold value of ratio for extensive group was 2.75 (left); that for poor group was 1.60 (right).
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