Superficial temporal artery to middle cerebral artery bypass in patient with atherosclerotic right internal carotid artery occlusive disease and impaired cerebral hemodynamics: a clinical case

Журнал "Сеченовский вестник".  Лист редактора к этой статье можно посмотреть здесь.

Sechenov Medical Journal. Editor's checklist for this article you can find here.

РЕЦЕНЗЕНТ А / REVIEWER A

ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW

Scientific quality: Grade A: Excellent

Language quality: Grade А: Priority publishing

Congratulations on your excellent surgery STA-MCA anastomosis for the patient with atherosclerotic ICA occlusion. I totally agree to the indication of this bypass procedure for not only to moyamoya patients but also the patient with atherosclerotic hemodynamically compromised status. The entire techniques were all accurate, meticulous to manage such small vessels, STA and M4. This video is educative for all Neurosurgeon and deserves to be published to SMJ.

CONCLUSION: accept for publication.

РЕЦЕНЗЕНТ B / REVIEWER B

ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW

Scientific quality: Grade A: Excellent

Language quality: Grade А: Priority publishing

Surgical treatment of internal carotid artery lesions, particularly occlusive forms, is an extremely pressing issue, as these lesions indicate an advanced stage of the disease, often accompanied by severe neurological deficits, disability, and enormous direct and indirect socioeconomic costs associated with treatment expenses.

Although surgical methods for treating internal carotid artery (ICA) lesions encompass a wide range of procedures—including microsurgical and endovascular techniques—these are associated with a high risk of complications and are primarily used to treat large and giant cerebral aneurysms, traumatic and spontaneous carotid cavernous sinuses, Moyamoya disease and Takayasu’s arteritis, and complex skull base tumors, the creation of an alternative route for blood outflow to bypass the affected vascular segment by forming an extra-intracranial anastomosis for the treatment of occlusive cerebrovascular disease is of great interest.

It is noteworthy that there are few publications in both domestic and international literature describing cases of treatment for stenotic and occlusive, embolically dangerous stenoses of the internal carotid artery through the creation of a microsurgical bypass anastomosis, when the options for endovascular and other types of surgical interventions have been exhausted due to high risk, anatomical features of the vessels, or contraindications for dual antiplatelet therapy.

Thus, the presented clinical case with intraoperative video footage clearly demonstrates the feasibility of microsurgical cerebral revascularization with good treatment outcomes for types of cerebrovascular pathology that previously could not be radically cured or were considered inoperable, and it merits publication in a leading scientific journal.

CONCLUSION: accept for publication.

РЕЦЕНЗЕНТ C / REVIEWER C

ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW

Scientific quality: Grade A: Excellent

Language quality: Grade А: Priority publishing

Outstanding quality of the clinical case material. Congratulations!

CONCLUSION: accept for publication.

РЕКОМЕНДАЦИИ НАУЧНЫХ РЕДАКТОРОВ ЖУРНАЛА / RECOMMENDATIONS

OF THE SCIENTIFIC EDITORS OF THE JOURNAL

ПЕРВЫЙ РАУНД РЕЦЕНЗИРОВАНИЯ / FIRST ROUND OF PEER-REVIEW

The manuscript presents a technically demanding and clinically relevant video case report of a superficial temporal artery-middle cerebral artery (STA–MCA) bypass in a patient with atherosclerotic occlusion of the right internal carotid artery and impaired cerebral hemodynamics. The topic is fully aligned with the scope of the journal and will be of interest to cerebrovascular neurosurgeons and clinicians involved in surgical cerebral revascularization. The case is well chosen, illustrates decision making in a complex hemodynamic scenario, and has clear educational potential in terms of operative technique and perioperative imaging.

However, the manuscript requires substantive scientific and editorial refinement to meet the standards of a print article accompanying a video.

1)        The manuscript should be clearly positioned as a case report with an associated surgical video, with standardized bilingual title, article type, section heading (“Neurosurgery / Video case report”), and affiliations harmonized between the Russian and English versions. The abstract must be expanded into a conventional structured summary (background, case description, main findings and postoperative course, conclusions) that is self-sufficient and does not rely on the video narration.

2)        Keywords and MeSH terms should be aligned with the actual focus of the article (cerebral revascularization, STA–MCA bypass, ischemic stroke, internal carotid artery occlusion, cerebral blood volume) and kept consistent across both language versions.

3)        The main text in its current form largely reproduces the video commentary and therefore needs to be reshaped into an autonomous case report with a clear narrative structure. It is recommended to organize the manuscript into the following sections: Introduction, Case description, Surgical technique, Postoperative course and follow up, Discussion, and Conclusion.

4)        The case description should provide a more comprehensive clinical picture, including cardiovascular comorbidities, neurological status, detailed CT angiography and perfusion findings, and explicit justification for choosing STA–MCA bypass in the context of chronic right ICA occlusion and bilateral hemodynamic impairment.

5)        The surgical technique should be described as a coherent sequence of key steps rather than as a time coded transcript, emphasizing the specific technical nuances that make the procedure educationally valuable (preoperative STA mapping, modified STA dissection using hooks, recipient vessel preparation, “fish mouth” configuration of the donor, suture strategy to prevent anastomotic narrowing, intraoperative indocyanine green angiography and Doppler verification).

6)        The results and postoperative course should be presented in a dedicated section, summarizing imaging outcomes (bypass patency, absence of hemorrhage or new ischemia, quantitative change in cerebral blood volume), clinical evolution, and duration of follow up without recurrent stroke. This will allow readers to evaluate both technical success and short  to midterm safety and effectiveness.

7)        The discussion should be expanded beyond a descriptive commentary and integrated with the current evidence base on extracranial–intracranial bypass surgery. It is advisable to briefly review historical EC/IC bypass trials, contemporary data identifying subgroups with hemodynamic compromise who may benefit from surgery, and the place of STA–MCA bypass among low flow and high flow revascularization strategies. The presented case should be explicitly positioned within this context, highlighting indications, patient selection, and the rationale for the chosen technique.

CONCLUSION: major revision

ВТОРОЙ РАУНД РЕЦЕНЗИРОВАНИЯ / SECOND ROUND OF PEER-REVIEW

The revised manuscript adequately addresses the concerns raised during the initial review and now meets the scientific and editorial standards of the journal. The authors have substantially strengthened the narrative structure, transforming the submission from a video transcript into a fully developed, autonomous case report that can be read and cited independently of the video. The clinical description, imaging data, and operative details are now presented in a clear, coherent manner that will be informative for neurosurgeons and other specialists involved in cerebral revascularization.

The abstract has been expanded and structured, with a concise summary of the clinical context, case characteristics, key procedural aspects, and postoperative outcomes. Keywords and MeSH terms have been aligned with the actual focus of the article, and the bilingual metadata (title, affiliations, contact information, ethics, conflict of interest, funding, abbreviations, author contributions) have been harmonized according to journal style. The main text now follows a logical sequence (Introduction, Case report, Surgical technique, Postoperative course, Discussion, Conclusion), with sufficient clinical detail and clear justification of indications for STA–MCA bypass in the context of chronic carotid occlusion and documented hemodynamic impairment.

Importantly, the discussion has been significantly expanded and better integrated with the current literature on extracranial–intracranial bypass, carotid occlusion, and patient selection based on hemodynamic criteria. The authors position their case appropriately within this evidence base and highlight the educational value of the described technical nuances. The reference list has been updated and formatted to journal requirements, with relevant neurosurgical and cerebrovascular sources.

Considering these improvements, the manuscript is now suitable for publication as a video‑supported case report.

CONCLUSION: accept. The revised manuscript is approved for publication without further major changes.