The Wingsuit Tadpole technique for microvascular end-to-side anastomosis: from bench to bedside

Microvascular end-to-side anastomosis is a critical component of superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass procedures. Suboptimal suturing may result in stenosis or thrombosis. We developed the wingsuit tadpole (WT) technique to enhance intraluminal support, thereby improving suturing precision and efficiency. The WT technique utilizes a tadpole-shaped rubber device inserted into the fish-mouth incision of the anastomosis. Detailed suturing protocols were established, and the technique was validated in rat femoral vessel models, with the standard bypass technique serving as a historical control. Recipient clamp times were analyzed using cumulative sum (CUSUM) statistics. Bypass patency was assessed immediately and at delayed intervals. A clinical case employing this technique is also presented. In animal training models, the mean recipient clamp time was significantly lower in the WT technique group than in the standard technique group (30±8 minutes vs. 36±9 minutes, p=0.023). CUSUM analysis for the WT group indicated that 12 training models were required to transition from the learning phase to the mastery phase, with recipient clamp time decreasing from 35±8 minutes to 25±6 minutes (p=0.002) and suturing time from 29±8 minutes to 20±6 minutes (p=0.006). Immediate patency was achieved in all models, with a delayed patency rate of 96% (23/24). In the clinical case, the MCA clamp time was 25 minutes, and bypass patency was maintained intraoperatively and at 3 months. The WT technique minimizes technical errors, reduces suturing time, and facilitates eversion alignment through intraluminal support. Its high trainability and short learning curve render it a practical and effective method for bypass neurosurgery.