1105. Half-tied Stay Suture Technique for Cerebrovascular End-to-side Anastomosis: A Technique to Expand the View of the Hidden Ostium

Authors: Satoru Shimizu, MD (Sagamihara, Japan)

Introduction: In cerebrovascular end-to-side anastomosis, thick, hard donor arteries overlying thin recipient arteries, intimal dissection, and/or the location of the recipient vessels along the craniotomy edge, impair the view of the ostium, and may result in occlusion of the anastomosis. To improve the intraoperative view, we modified the stay sutures. Methods: After performing standard recipient arteriotomy and placing the first stay suture, we half-tied the second stay suture to leave a loop. The half-tied stay suture (HSS) and its threads were secured with a clip to avoid slippage. The donor artery was revolved to the opposite side of side A using the first stay suture as a fulcrum. Under the expanded view of the ostium, untied interrupted sutures were placed on side A. Then the donor vessel was revolved to the opposite side and side B was sutured in the same manner. Lastly, the HSS and all other sutures were tied fully. Our HSS method was used in three adults who underwent superficial temporal- to middle cerebral artery anastomosis despite anticipated poor visibility of the ostium. Results: Compared with the conventional method, the view of the ostium was expanded with less manipulation of the vessel walls. There were no complications, and the anastomosis remained patent in all patients. Conclusion: This simple modification of the stay sutures reduces the risk of anastomotic occlusion due to iatrogenic vascular damage by excessive manipulation.