Article Figures & Data
- Figure 1
Flowchart of the procedure and subgrouping. CCA, common carotid artery; ECA, external carotid artery; EPO, erythropoietin; ICA, internal carotid artery; MBH, multiple burr hole; MMA, middle meningeal artery; STA, superficial temporal artery; TFCA, transfemoral cerebral angiography.
- Figure 2
Comparison of the revascularisation patterns of the intracalvarial external carotid artery dominancy and extracalvarial external carotid artery dominancy. *As compared with the extracalvarial ECA revascularisation pattern, there is no transcalvarial arteriogenesis in the intracalvarial ECA revascularisation pattern. †Revascularisation confirmed by transfemoral cerebral angiography after 6 months from multiburr hole operation. CBF, cerebral blood flow; CBV, cerebral blood volume; CTP, CT perfusion; DWI, diffusion-weighted image; ECA, external carotid artery; mRS, modified Rankin Scale; MTT, mean transit time; TTP time-to-peak.
- Figure 3
Perfusion changes on the treated hemisphere before and after combined therapy. In comparison to the balanced revascularisation group, both the intracalvarial and extracalvarial revascularisation groups showed significant perfusion changes before and after the combined treatment. CBF, cerebral blood flow; CBV, cerebral blood volume; MTT, mean transit time; TTP, time-to-peak.
- Figure 4
An illustrative case that highlights the haemodynamic changes in the external carotid artery (ECA) during the follow-up period. In this case, the ECA exhibited a transformation to a low-resistance ECA Doppler sonography waveform (indicated by the red box), which is referred to as ‘internalization of the ECA’. This change was observed in conjunction with the intracalvarial ECA revascularisation pattern in the 6-month transfemoral cerebral angiography follow-up. The figure illustrates how the ECA’s blood flow dynamics underwent a significant alteration as a result of the intracalvarial ECA revascularisation process.
- Table 1
Clinical characteristics of the population in this study
Study population
(n=87)Age 51.8±14.9 Sex, male 40 (46.0%) HTN 50 (57.5%) DM 23 (26.4%) Smoking 21 (24.1%) Family history 12 (13.8%) Presenting symptoms Hemiparesis 47 (54.0%) Dysarthria 3 (3.5%) Cortical symptoms 23 (26.4%) Visual symptoms 2 (2.3%) Ataxia 1 (1.2%) Dizziness 1 (1.2%) Others 10 (11.5%) Clinical course during hospitalisation Stroke 2 (2.3%) TIA 4 (4.6%) Admission NIHSS 2 (0, 5) Admission mRS 1 (0, 4.0) Follow-up after discharge Total follow-up period (year, IQR) 5.2 (3.1–9.2) At 6 month mRS (IQR) 1 (0–2) Recurrence of stroke 3/87 (3.4%) Deterioration on CTP 3/71 (4.2%) CTP, CT perfusion; DM, diabetes mellitus; HTN, hypertension; mRS, modified Rankin scale; NIHSS, National Institute of Health Stroke Scale; TIA, transient ischaemic attack.
- Table 2
Ultrasonographic haemodynamic changes according to revascularisation patterns: before and after treatment
Revascularisation patterns
(n=70/103 hemispheres)Haemodynamics of ICA P Haemodynamics of ECA P value Pre-procedure Post-procedure Pre-procedure Post-procedure Intracalvarial ECA (n=39) MAV (cm/s) 26.1±20.1 28.5±17.9 0.230 46.2±14.2 51.5±12.1 0.057 Flow volume (mL/min) 112.4±88.7 110.5±95.1 0.877 163.9±80.0 212.9±88.3 0.005 Pulsatility index 1.35±0.79 1.44±0.82 0.533 1.90±0.40 1.67±0.33 0.001 Resistance index 0.66±0.18 0.69±0.19 0.511 0.83±0.08 0.78±0.08 <0.001 Extracalvarial ECA (n=15) MAV (cm/s) 37.9±18.3 33.5±18.5 0.395 51.8±19.4 49.3±15.3 0.584 Flow volume (mL/min) 210.8±164.2 196.3±208.4 0.677 230.6±117.8 181.7±55.4 0.155 Pulsatility index 1.07±0.63 1.29±0.59 0.078 1.72±0.46 1.63±0.45 0.413 Resistance index 0.59±0.16 0.67±0.15 0.043 0.79±0.09 0.77±0.10 0.285 Balanced (n=16) MAV (cm/s) 29.1±16.0 29.6±14.3 0.8941 38.0±11.3 40.3±10.2 0.559 Flow volume (mL/min) 134.7±96.4 208.0±238.4 0.199 179.6±77.6 190.3±95.5 0.603 Pulsatility index 1.10±0.25 1.28±0.58 0.305 2.06±053 1.92±0.51 0.300 Resistance index 0.63±0.09 0.66±0.14 0.365 0.86±0.09 0.83±0.09 0.302 ECA, external carotid artery; ICA, internal carotid artery; MAV, mean arterial velocity.
Supplementary Materials
Supplementary data
Additional Files
Supplementary Data
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