The anterior temporal artery: an underutilized but robust donor for revascularization of the distal middle cerebral artery

Abstract

OBJECTIVE The anterior temporal artery (ATA) supplies an area of the brain that, if sacrificed, does not cause a noticeable loss of function. Therefore, the ATA may be used as a donor in intracranial-intracranial (IC-IC) bypass procedures. The capacities of the ATA as a donor have not been studied previously. In this study, the authors assessed the feasibility of using the ATA as a donor for revascularization of different segments of the distal middle cerebral artery (MCA). METHODS The ATA was studied in 15 cadaveric specimens (8 heads, excluding 1 side). First, the cisternal segment of the artery was untethered from arachnoid adhesions and small branches feeding the anterior temporal lobe and insular cortex, to evaluate its capacity for a side-to-side bypass to insular, opercular, and cortical segments of the MCA. Any branch entering the anterior perforated substance was preserved. Then, the ATA was cut at the opercular-cortical junction and the capacity for an end-to-side bypass was assessed. RESULTS From a total of 17 ATAs, 4 (23.5%) arose as an early MCA branch. The anterior insular zone and the frontal parasylvian cortical arteries were the best targets (in terms of mobility and caliber match) for a side-to-side bypass. Most of the insula was accessible for end-to-side bypass, but anterior zones of the insula were more accessible than posterior zones. End-to-side bypass was feasible for most recipient cortical arteries along the opercula, except for posterior temporal and parietal regions. Early ATAs reached significantly farther on the insular MCA recipients than non-early ATAs for both side-to-side and end-to-side bypasses. CONCLUSIONS The ATA is a robust arterial donor for IC-IC bypass procedures, including side-to-side and end-to-side techniques. The evidence provided in this work supports the use of the ATA as a donor for distal MCA revascularization in well-selected patients.

Angiographic Systems for Classifying Distal Arterial Occlusions

“…The vascular territory supplied by the anterior temporal artery can be occasionally variable. It may supply some parts of the eloquent posterior temporal cortex, especially if the middle temporal and/or posterior temporal arteries are small [26]. Khatri et al [27] in their review of 886 cerebral angiograms concluded that the anterior temporal artery, regardless of its size, was not considered to determine the main MCA bifurcation pattern, whereas Goyal et al stated that anterior temporal artery is not considered M2; however, if the artery is large, i.e., supplies territories outside those of the anterior temporal artery such as posterior temporal or low parietal region, it should be considered as M2 [14].…”

“…The vascular territory supplied by the anterior temporal artery can be occasionally variable. It may supply some parts of the eloquent posterior temporal cortex, especially if the middle temporal and/or posterior temporal arteries are small [26]. Khatri et al [27] in their review of 886 cerebral angiograms concluded that the anterior temporal artery, re- [18] From the origin of the main trunk at the ICA to its main divisions (bifurcation)…”