Despite failure of “The EC/IC Bypass Study Group” to demonstrate effectiveness in minimizing future stroke events, STA-MCA bypass remains an essential treatment for complex giant intracranial aneurysms (GIA), tumors, Moyamoya disease with ischemia, and atherosclerotic steno-occlusive disease with hemodynamic cerebrovascular insufficiency. The objective of this publication is to describe a novel suturing technique developed by the senior author (AFK) for STA-MCA bypass, which helps reduce donor-recipient anastomosis time allowing for a well-organized systematic workflow.
Step 1 involves passing the needle of a 9-O Prolene (Ethicon Inc. a subsidiary of Johnson and Johnson) suture from out-to-in on the donor vessel followed by in-to-out on the recipient vessel. Step 2: Before cutting and tying a knot as per the established method of suturing, repeat step 1 and leave the needle “parked” creating a loop, which is then cut at its proximal end. Step 3: Tie knots using the jeweler’s forceps (Aesculap). Repeat previous steps until there are enough throws to seal the bypass adequately.
and Discussion: The STA-MCA bypass serves as a principal method for flow augmentation. The technique described here allows for more efficient and organized microsurgical movements reducing vessel tissue manipulation and clamp time.
We describe a novel technique for interrupted STA-MCA bypass suturing that adds efficiency, safety, organization, and operative ease compared to the conventional method of interrupted vessel suturing.

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