Temporary Steno-occlusive Change in the Donor Artery During Mouth Opening (Big Bite Ischemic Phenomenon) After Superficial Temporal Artery to Middle Cerebral Artery Bypass in Adult Patients with Moyamoya Disease and Atherosclerosis.

Publisher: Springer-Verlag Country of Publication: Austria NLM ID: 100962752 Publication Model: Print Cited Medium: Print ISSN: 0065-1419 (Print) Linking ISSN: 00651419 NLM ISO Abbreviation: Acta Neurochir Suppl Subsets: MEDLINE

Original Publication: Wien ; New York : Springer-Verlag, c1994-

Cerebral Revascularization* ; Hemodynamics*; Arterial Occlusive Diseases/*epidemiology ; Intracranial Arteriosclerosis/*surgery ; Middle Cerebral Artery/*surgery ; Moyamoya Disease/*surgery ; Postoperative Complications/*epidemiology ; Temporal Arteries/*surgery; Adult ; Aged ; Arterial Occlusive Diseases/diagnostic imaging ; Arterial Occlusive Diseases/physiopathology ; Computed Tomography Angiography ; Female ; Humans ; Intracranial Arteriosclerosis/etiology ; Male ; Middle Aged ; Middle Cerebral Artery/diagnostic imaging ; Mouth ; Moyamoya Disease/complications ; Postoperative Complications/diagnostic imaging ; Postoperative Complications/physiopathology ; Temporal Arteries/diagnostic imaging ; Temporal Arteries/physiopathology ; Ultrasonography

Background: Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is one of the most common surgical procedures performed for direct extracranial (EC) to intracranial (IC) bypasses. We describe a temporary steno-occlusive change in the STA that was caused by mouth opening after the STA-MCA bypass (so-called big bite ischemic phenomenon) in an adult patient with moyamoya disease. The aim of this study was to assess the incidence of this phenomenon in patients with atherosclerosis.
Methods: Adult patients with ischemic cerebrovascular disease who underwent STA-MCA anastomosis were included in this study. Ultrasound examinations were postoperatively performed on 62 sides to determine whether mouth opening affected the blood flow of the donor STA and resulted in any ischemic symptoms within 1 min. Computed tomography angiography was performed during both mouth opening and closing when blood flow changes were recognized in the donor STA.
Results: During wide mouth opening, steno-occlusion of the donor STA occurred in 8 of the 62 affected sides (12.9 %), which included 3 of the 47 sides (6.4 %) in patients with atherosclerosis and 5 of the 15 sides (33.3 %) in patients with moyamoya disease.
Conclusion: Steno-occlusion of the donor STA occurred during wide mouth opening in 12.9 % of the sides of adult patients who had undergone STA-MCA anastomosis. This phenomenon was more common in patients with moyamoya disease than in patients with atherosclerosis.

Keywords: Donor artery; Mouth opening; Occlusion; STA-MCA bypass; Temporal muscle

Date Created: 20160918 Date Completed: 20171011 Latest Revision: 20171011

20221213

10.1007/978-3-319-29887-0_17

27637638