A comparison of haemodynamics between subcranial-intracranial bypass and the traditional extracranial-intracranial bypass

Abstract

Background: Ischemic cerebrovascular diseases are traditionally treated using an extracranial-intracranial (EC-IC) bypass. The use of the internal maxillary artery (IMA) in the subcranial-intracranial (SC-IC) bypass was recently described as an alternative treatment. However, the haemodynamics of this new approach have not been defined.

Methods: The haemodynamic parameters (flow volume [FV], internal diameter [ID], time-averaged mean velocity [TAM], pulsatility index [PI] and resistance index [RI]) of the IMA-radial artery graft (RAG)-middle cerebral artery (MCA) (n = 12) bypass and superficial temporal artery (STA)-MCA bypass (n = 18) were measured using intraoperative duplex ultrasonography and compared.

Results: The FV was 81.36 ± 30.41 (62.05–100.70) ml/min for the IMA-RAG-MCA bypass. This was significantly higher than that of the STA-MCA bypass (27.25 ± 9.32 (22.62–31.88) ml/min; P < .01). The ID and TAM in the IMA-RAG-MCA bypass were higher than in the STA-MCA bypass (P < .01; P < .01). No significant differences were observed in PI (P ≈ .21) and RI (P ≈ .08). The early patency rate (one month after the operation) was 100% for the IMA-RAG-MCA bypass and 94% for the STA-MCA bypass.

Conclusions: The IMA-RAG-MCA bypass provides moderate to high blood flow to the revascularized territory and blood flow was higher by this method than the STA-MCA bypass.

Keywords:

• Extracranial-intracranial bypass
• subcranial-intracranial bypass
• intraoperative duplex ultrasonography
• haemodynamics

Disclosure statement

The National Natural Science Foundation of China provided financial support in the form of National Natural Science funding (81271520). The sponsor had no role in the design or conduct of this research. The authors declare no financial or other conflicts of interest in relation to this research and its publication.

Additional information

Funding

The National Natural Science Foundation of China provided financial support in the form of National Natural Science funding (81271520). The sponsor had no role in the design or conduct of this research.