FAILURE OF EXTRACRANIAL INTRACRANIAL ARTERIAL BYPASS TO REDUCE THE RISK OF ISCHEMIC STROKE - RESULTS OF AN INTERNATIONAL RANDOMIZED TRIAL
FAILURE OF EXTRACRANIAL INTRACRANIAL ARTERIAL BYPASS TO REDUCE THE RISK OF ISCHEMIC STROKE - RESULTS OF AN INTERNATIONAL RANDOMIZED TRIAL
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DOI：
10.1056/nejm198511073131904
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发表时间：
1985-01-01
影响因子：
158.5
通讯作者：
BARNETT, HJM
中科院分区：
文献类型：
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作者：
BARNETT, HJM
为了确定旁路手术是否会使患有症状性颈内动脉动脉粥样硬化疾病的患者受益，我们研究了1377名近期患有半球中风、视网膜梗死或短暂性脑缺血发作的患者，这些患者患有同侧颈内动脉或大脑中动脉的动脉粥样硬化狭窄或闭塞。其中，714人被随机分配到最好的医疗护理，663人被分配到相同的方案，并增加了连接颞浅动脉和大脑中动脉的搭桥手术。患者平均随访55.8个月。30天手术死亡率和严重中风发病率分别为0.6%和2.5%。术后旁路通畅率为96%.Nonfatal和致命性中风发生更频繁和更早的患者operatedon. Secondary生存分析比较两组的主要中风和所有死亡，所有中风和所有死亡，并为同侧缺血性中风证明了类似的缺乏手术的好处。对不同血管造影病变患者的单独分析未发现手术获益的亚组。手术组中有两个重要的亚组患者的情况明显更糟：大脑中动脉重度狭窄患者（n = 109，Mantel-Haenszel卡方= 4.74）和颈内动脉闭塞后持续缺血症状患者（n = 287，卡方= 4.04）。因此，本研究未能证实颅外-颅内吻合术可有效预防颈动脉和大脑中动脉粥样硬化性动脉疾病患者的脑缺血。
To determine whether bypass surgery would benefit patients with symptomatic atherosclerotic disease of the internal carotid artery, we studied 1377 patients with recent hemisphere strokes, retinal infarction, or transient ischemic attacks who had atherosclerotic narrowing or occlusion of the ipsilateral internal carotid or middle cerebral artery. Of these, 714 were randomly assigned to the best medical care, and 663 to the same regimen with the addition of bypass surgery joining the superficial temporal artery and the middle cerebral artery. The patients were followed for an average of 55.8 months. Thirty-day surgical mortality and major stroke morbidity rates were 0.6 and 2.5 per cent, respectively. The postoperative bypass patency rate was 96 per cent. Nonfatal and fatal stroke occurred both more frequently and earlier in the patients operated on. Secondary survival analyses comparing the two groups for major strokes and all deaths, for all strokes and all deaths, and for ipsilateral ischemic strokes demonstrated a similar lack of benefit from surgery. Separate analyses in patients with different angiographic lesions did not identify a subgroup with any benefit from surgery. Two important subgroups of patients fared substantially worse in the surgical group: those with severe middle-cerebral-artery stenosis (n = 109, Mantel-Haenszel chi-square = 4.74), and those with persistence of ischemic symptoms after an internal-carotid-artery occlusion had been demonstrated (n = 287, chi-square = 4.04). This study thus failed to confirm the hypothesis that extracranial-intracranial anastomosis is effective in preventing cerebral ischemia in patients with atherosclerotic arterial disease in the carotid and middle cerebral arteries.