Аннотация:Context: Physiological insights into blood flow alterations in cortical vessels after superfcial
temporal artery‑middle cerebral artery (STA‑MCA) bypass surgery are important for the prognosis
of bypass sustainability and hemodynamic patency. Aims: This study aims to assess the impact
of STA‑MCA bypass on local hemodynamics for patients with symptomatic carotid occlusions
and Moyamoya disease. Settings and Design: This article presents a prospective nonrandomized
study of intraoperative blood flow measurements in cortical branches of MCA and donor
vessel before and after cerebral revascularization. Materials and Methods: Evaluation of local
hemodynamic parameters was established for 112 patients with symptomatic carotid occlusive
disease and cerebrovascular insuffciency during STA‑MCA bypass surgery. We used intraoperative
Doppler ultrasonography (89 patients – 72%), flowmetry (56 cases – 50%), and in 33 cases both
methods. For physical justifcation of observed facts, we performed computational simulation
with OpenFOAM CFD framework using Navier‑Stokes nonstationary hemodynamic model.
Statistical Analysis Used: All calculations were performed with IBM SPSS Statistics version 10.0
software. We used parametric (Z‑test and Student’s t‑test) and nonparametric models (Wilcoxon,
Mann–Whitney). For categorical values, we used Fisher’s exact test. Results: Local cerebral
hemodynamics after revascularization surgery signifcantly depended on initial perfusion defcit and
the ability of bypass to reverse the blood flow in proximal parts of cortical artery (86 cases, 77%).
Mechanism of cortical blood flow alteration was related to donor vessel cut flow value and potential
consumption threshold of acceptor artery. Conclusions: Knowledge of hemodynamic principles of
flow redistribution after STA‑MCA bypass is important to improve bypass stainability and leads to
better revascularization results.
