Double-barrel STA-MCA bypass for cerebral revascularization: lessons learned from a 10-year experience

Area of Science:

• Neurosurgery
• Cerebrovascular Surgery
• Microsurgery

Background:

• Extracranial-intracranial (EC-IC) bypass is crucial for cerebral revascularization in select patients.
• Traditional superficial temporal artery-middle cerebral artery (STA-MCA) bypass uses a single STA branch.
• The double-barrel STA-MCA bypass technique utilizes both STA branches to augment flow to distinct MCA territories.

Purpose of the Study:

• To evaluate the feasibility, safety, and efficacy of the double-barrel STA-MCA bypass technique.
• To assess graft patency, cerebral perfusion improvement, and patient outcomes.
• To compare perioperative complication rates with traditional single-anastomosis bypass.

Main Methods:

• Review of consecutive double-barrel STA-MCA bypasses performed between 2010 and 2020.
• Anastomoses directed to at-risk territories based on preoperative imaging and intraoperative data.
• Postoperative evaluation using CT perfusion and CTA; assessment of perioperative outcomes and mRS scores.

Main Results:

• Successful double-barrel STA-MCA bypass performed on 54 cerebral hemispheres in 44 patients.
• 100% intraoperative graft patency and 98.1% long-term patency.
• 88.2% improvement in cerebral perfusion; low complication rates and improved functional outcomes (mean mRS 1.15 at follow-up).

Conclusions:

• The double-barrel STA-MCA bypass demonstrates high intraoperative and postoperative patency rates, supporting its feasibility.
• Perioperative complication rates are comparable to single-anastomosis bypass.
• Improved functional outcomes and perfusion confirm the efficacy and safety of this dual-anastomosis technique.