Article Figures & Data
Figures
- Figure 1
A schematic diagram of the two bypass procedures. (A) STA-M2 bypass; (B) clip reconstruction and STA-M2 bypass; (C) double reimplantation technique of STA-M2 bypass; (D) STA-RAG-M2 bypass. RAG, radial artery graft; STA, superficial temporal artery.
- Figure 2
Postprocessing cascade of the DSA image. (A) A colour-coded single image is obtained from DSA images of common carotid artery angiography; then, we draw selected ROIs along the superficial temporal artery (STA). A reference ROI is drawn within the distal middle cerebral artery (MCA) of the aneurysm. (B) The time-attenuation intensity curve is obtained automatically. The green line represents the time-attenuation intensity curve within the STA, and the red line represents that of the MCA. (C) Using the time-attenuation intensity curve, we calculated the AUC within the STA, adjusted by the MCA. AUC, area under the curve; DSA, digital subtraction angiography; ROI, region of interest.
- Figure 3
The area under the receiver operating characteristic curve was 0.763 (95% CI, 0.906 to 1.000; p<0.001). Recipient/donor flow index >2.3 predicted postoperative insufficient flow-related stroke with the highest combination of sensitivity (83.3%) and specificity (100%). AUC, area under the curve.
- Figure 4
Representative case. (A) Left internal carotid artery (ICA) lateral angiographic injection confirmed the patency of the graft. (B) Left ICA lateral angiographic injection showed the diameters of STA and MCA were 1.86 mm and 2.39 mm, respectively. (C) Quantitative DSA showed the recipient/donor flow index was 2.6. (D) CT showed a territory infarction in the MCA area. AUC, area under the curve; DSA, digital subtraction angiography; MCA, middle cerebral artery; ROI, region of interest; STA, superficial temporal artery.
Tables
- Table 1
Clinical summary of 20 patients with aneurysms who underwent bypass treatment
Patient Age group/sex mRS at AM Presentation Deficits Location Type Diameter Complications mRS at DC 1 30–40/M 1 Headache None L ICA terminus Saccular 40 mm Hemiplegia 3 2 30–40/F 1 Headache None L MCA Serpentine 40 mm Aphasia 2 3 20–30/M 1 Blindness/ophthalmoplegia CN II/IIII L clinoid ICA Serpentine 50 mm Same as preop 1 4 30–40/F 1 Incidental None R ICA terminus Saccular 35 mm Hemiplegia 3 5 20–30/F 1 Headache None R MCA Serpentine 31 mm None 0 6 40–50/M 0 Incidental None L MCA Saccular 25 mm None 0 7 40–50/F 1 SAH None R ICA terminus Saccular 27 mm Hemiplegia 4 8 20–30/F 1 Headache None L MCA Saccular 38 mm Motor weakness 1 9 20–30/F 1 Diplopia CN III R MCA Serpentine 75 mm Hemiplegia 4 10 20–30/F 1 Headache None L MCA Saccular 30 mm None 0 11 30–40/M 1 Seizure None R MCA Saccular 35 mm Hemiplegia 3 12 40–50/F 0 Incidental None R MCA Saccular 15 mm None 0 13 40–50/M 1 SAH None L MCA Saccular 25 mm Hemiplegia 4 14 40–50/M 1 SAH None R MCA Saccular 30 mm Motor weakness 1 15 40–50/F 1 Headache None L MCA Saccular 30 mm Hemiplegia 4 16 50–60/F 1 Headache None L ICA terminus Saccular 50 mm None 0 17 30–40/F 1 Headache None L clinoid ICA Saccular 40 mm Hemiplegia 4 18 40–50/M 1 Motor weakness None R MCA Serpentine 50 mm None 0 19 30–40/F 1 SAH None L MCA Saccular 28 mm None 0 20 50–60/F 1 Blindness CN II L ICA terminus Saccular 19 mm Hemiplegia 4 AM, admission; CN, cranial nerve; DC, discharge; ICA, internal carotid artery; L, left; MCA, middle cerebral artery; mRS, modified Rankin Scale; R, right; SAH, subarachnoid haemorrhage.
- Table 2
Clinical characteristics and DSA parameters versus IRS
Characteristic Total (n=20) IRS P value OR (95% CI) Adjusted p value Present (n=12) Absent (n=8) Mean age, years 38.1±11.6 38.0±11.0 38.1±13.1 0.982 — — Sex 0.848 1.08 (0.50 to 2.33) — Male 7 (35.0) 4 (33.3) 3 (37.5) Female 13 (65.0) 8 (66.7) 5 (62.5) Medical history Smoking 4 (20.0) 2 (16.7.0) 2 (25.0) 0.648 1.25 (0.44 to 3.58) — Drinking 2 (10.0) 1 (8.3) 1 (12.5) 0.761 1.22 (0.29 to 5.13) — Diabetes 1 (5.0) 0 (0) 1 (12.5) 0.209 — — Hypertension 3 (15.0) 2 (16.7) 1 (12.5) 0.798 0.88 (0.36 to 2.16) — Size, mm 35.8±13.3 37.7±14.9 33.8±12.1 0.528 — — Location 0.444 1.32 (0.67 to 2.64) — ICA 7 (35.0) 5 (41.7) 2 (25.0) MCA 13 (65.0) 7 (58.3) 6 (75.0) Shape 0.550 1.29 (0.53 to 3.13) — Saccular 14 (70.0) 9 (75.0) 5 (62.5) Serpentine 6 (30.0) 3 (25.0) 3 (37.5) RDFI 2.6±1.2 3.3±1.0 1.5±0.4 <0.001 132.17 (1.28 to 13 606.13)* 0.039 RDDI 1.3±0.3 1.3±0.3 1.3±0.2 0.905 0.615 (0.12 to 30.787)* 0.808 Data are presented as n (%) or mean±SDs, unless otherwise indicated.
*Adjusted for age, sex, smoking and hypertension.
DSA, digital subtraction angiography; ICA, internal carotid artery; IRS, insufficient flow-related stroke; MCA, middle cerebral artery; RDDI, recipient/donor diameter index; RDFI, recipient/donor flow index.
