Cross-Comparison of 4-Dimensional Flow Magnetic Resonance Imaging and Intraoperative Middle Cerebral Artery Pressure Measurements Before and After Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery

• Published in: Neurosurgery Vol. 89; no. 5; pp. 909 - 916
• Main Authors: Sekine, Tetsuro, Murai, Yasuo, Orita, Erika, Ando, Takahiro, Takagi, Ryo, Amano, Yasuo, Matano, Fumihiro, Iwata, Kotomi, Ogawa, Masashi, Obara, Makoto, Kumita, Shinichiro
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.11.2021; Wolters Kluwer Health, Inc
• Subjects: Atherosclerosis; Cerebral Revascularization; Cerebrovascular Circulation; Heart surgery; Hemodynamics; Humans; Magnetic Resonance Imaging; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - surgery; Temporal Arteries - diagnostic imaging; Temporal Arteries - surgery; Veins & arteries; 4D flow MRI; STA-MCA bypass; Intracranial hemodynamics; Cerebral blood flow; Atherosclerotic steno-occlusive disease; Intraoperative pressure measurements
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyab305

Abstract BACKGROUND The hemodynamic changes after superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery are unclear. OBJECTIVE To clarify the hemodynamics by comparing flow parameters obtained by 4-dimensional (4D) flow magnetic resonance imaging (MRI) and intraoperative MCA pressure measurement. METHODS We recruited 23 patients who underwent STA-MCA bypass surgery for internal carotid artery (ICA) or MCA stenosis. We monitored intraoperative MCA, STA, and radial artery (RA) pressure. All patients underwent 4D flow MRI preoperatively and 3 wk after surgery to quantify the blood flow volume (BFV) of the ipsilateral ICA (BFViICA), contralateral ICA (BFVcICA), basilar artery (BFVBA), ipsilateral STA (BFViSTA), and contralateral STA (BFVcSTA). The sum of intracranial BFV was defined as BFVtotal. We compared BFV parameters and intraoperative pressure. RESULTS BFViSTA significantly increased after surgery (P < .001). BFViICA and BFVBA significantly decreased after surgery (BFViICAP = .005; BFVBAP = .02). No significant difference was observed between BFVcICA before and after surgery. As a result, BFVtotal postoperatively increased by 6.8%; however, no significant difference was observed. Flow direction at M1 changed from antegrade to unclear after surgery in 5 patients. Intraoperative MCA pressure and MCA/RA pressure ratio significantly increased after surgery (P < .001). We found a stronger positive correlation between MCA pressure increase ratio and BFVtotal increase ratio in patients with lower pre-MCA pressure (r = 0.907, P < .001). CONCLUSION The visual and quantitative assessment of 4D flow MRI revealed that intracranial blood flow changes complementarily after STA-MCA bypass surgery. 4D flow MRI may detect the improvement of cerebral perfusion pressure.