The "One Coin Bypass" Technique as a Minimally Invasive Navigation-Guided Superficial Temporal Artery to Middle...

Minimally invasive cerebral revascularization techniques are increasingly sought to reduce surgical trauma while preserving efficacy. The "One Coin bypass" (OCB) is a navigation-guided superficial temporal artery to middle cerebral artery (STA-MCA) bypass performed through a coin-sized craniectomy and 3.0 cm skin incision. This study aimed to evaluate its clinical feasibility and surgical benefits.

We retrospectively analyzed 29 patients who underwent single-vessel STA-MCA bypass for symptomatic internal carotid or MCA stenosis or occlusion between 2017 and 2022. The OCB was introduced in January 2021; earlier cases served as a historical control group. Surgical parameters and clinical outcomes were compared between the One Coin group (n = 10) and the conventional bypass group (n = 19).

The One Coin group had significantly shorter skin incisions (3.0 cm vs. 8.0 ± 2.3 cm, P < 0.05), smaller craniectomy diameter (17 mm vs. 45 ± 5.7 mm, P < 0.05), and reduced total operative time (136 ± 13.1 min vs. 219 ± 31.1 min, P < 0.05). Anastomosis times were comparable (P = 0.837). No major complications occurred in the One Coin group, while one infarction was noted in the conventional group. All bypasses remained patent.

The OCB was shown to be a safe and effective minimally invasive alternative to conventional STA-MCA bypass, offering reduced surgical exposure without compromising bypass quality. It may be especially advantageous in elderly or high-risk patients.