Surgical Efficacy, Safety, and Medium- to Long-Term Outcomes of Superficial Temporal Artery-Radial Artery Graft-A3 Bypass: A 18-Case Series.

Abstract

The efficacy of revascularization for hemodynamic ischemia in the anterior cerebral artery (ACA) territory, despite being part of the same internal carotid artery system as the middle cerebral artery territory, has not been thoroughly discussed. For patients with ACA ischemia, we perform revascularization using a superficial temporal artery (STA)-radial artery graft (RAG)-A3 bypass. Herein, we share our experience with this procedure. This study involved 18 patients who underwent STA-RAG-A3 bypass at our hospital from April 2018 to July 2024. We investigated the patients' preoperative and postoperative status, including bypass patency, changes in hemodynamics, symptoms, neurocognitive function after surgery, and surgery-related complications. The patency rate of the STA-RAG-A3 bypass at the final follow-up was 100% (mean follow-up period of 15.8 months), and no patients developed postoperative recurrence of their ischemic symptoms. Arterial spin labeling magnetic resonance imaging visually and qualitatively confirmed clear improvement in frontal lobe cerebral perfusion in all patients. No significant deterioration in neurocognitive function associated with surgery was observed. The revascularization to the ACA via the STA-RAG-A3 bypass is technically stable with favorable medium- to long-term patency, suggesting its potential as a treatment option for ACA ischemia. However, limitations remain due to patient selection and lack of objective data.