Superficial temporal artery-middle cerebral artery bypass for ischemic atherosclerotic middle cerebral artery disease.

Most recent studies on the effectiveness of cerebral revascularization have focused on the treatment of atherosclerotic internal carotid artery occlusive disease. The goal of the present study was to assess neurological function in 11 severe atherosclerotic middle cerebral artery (MCA) disease patients with transient ischemic attacks (TIAs) and hemodynamic compromise and determine the efficacy of superficial temporal artery-middle cerebral artery (STA-MCA) bypass. There were eight patients with MCA occlusion and three with severe MCA stenosis. After the bypass procedure, all 11 patients experienced reduction in TIAs and no stroke during a mean follow-up of 34.36 months. Surgical revascularization increased regional cerebral blood flow (mL/100g/min) from a mean of (+/- standard deviation) 25.9+/-7.39 preoperatively to 32.3+/-7.72 postoperatively, and improved regional cerebrovascular reactivity from -6.42%+/-14.61% to 30.14%+/-23.93% (p = 0.014) in the eight patients with atherosclerotic MCA occlusion. Our findings demonstrated the benefit of STA-MCA bypass for patients with medically refractory and symptomatic atherosclerotic MCA occlusion with hemodynamic compromise.