Effects of superficial temporal artery-middle cerebral artery bypass on hemodynamics and clinical outcomes in the patients with atherosclerotic stenosis in the intracranial segment of internal carotid artery and middle cerebral artery
Effects of superficial temporal artery-middle cerebral artery bypass on hemodynamics and clinical outcomes in the patients with atherosclerotic stenosis in the intracranial segment of internal carotid artery and middle cerebral artery
复制标题
颞浅动脉-大脑中动脉搭桥术对颈内动脉、大脑中动脉颅内段动脉粥样硬化性狭窄患者血流动力学及临床结局的影响
DOI：
10.1016/j.clineuro.2019.105510
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发表时间：
2019-11-01
影响因子：
1.9
通讯作者：
Wang, Hui
中科院分区：
文献类型：
--
作者：
Ning, Xin-Jie;Gao, Qun;Wang, Hui
目的：观察颞浅动脉-大脑中动脉搭桥术（STA-MCA搭桥术）对颈内动脉颅内段及（或）大脑中动脉粥样硬化性狭窄患者血流动力学及临床预后的影响。患者与方法：回顾性收集63例近3个月出现脑缺血症状、数字减影血管造影（DSA）显示颈内动脉（ISICA）和（或）大脑中动脉（MCA）颅内段狭窄或闭塞、CT灌注成像（CTP）显示脑灌注减少的患者资料。根据患者选择的不同治疗方式（STA-MCA搭桥和药物），将患者分为搭桥组（30例）和药物组（33例）。观察旁路组患者术后症状、吻合口通畅程度及血流动力学。记录两组治疗后缺血事件及临床结果，并进行两组间比较。结果：旁路组28例患者DSA均显示吻合口通畅（93.3%,28/30），术后3天和6个月，iii期CTP患者的CTP改善率均显著高于ii期CTP患者（95% vs 60%）。搭桥组治疗后缺血性事件发生率（13.3% vs 48.5%）和年卒中发生率（6.7% vs 25.6%）显著低于药物组（均P < 0.05）。署预处理美国国立卫生研究院的中风尺度分数和改良Rankin规模(夫人)分数两组之间没有显著差异,但署(2.87 + / - 0.19和2.4 + / - 0.19 vs 4.03 + / - 0.47和3.97 + / - 0.49)夫妇(1.13 + / - 0.09和1.0 + / - 0.07 vs 1.55 + / - 0.14和1.52 + / - 0.15)绕过组都明显低于药物组在治疗后6到24个月(P < 0.05)。结论：STA-MCA搭桥术对有ISICA和（或）mca相关症状、狭窄70%-100%、ictp期以上患者可改善脑血流灌注，降低脑卒中发生率。然而，这一结论还有待进一步证实。
Objective: To observe the effects of superficial temporal artery-middle cerebral artery bypass (STA-MCA bypass) on hemodynamics and clinical outcomes in the patients with atherosclerotic stenosis in the intracranial segment of internal carotid artery and (or) middle cerebral artery.Patients and methods: The data of 63 patients who had the symptoms of cerebral ischemia in recent 3 months, intracranial segment of internal carotid artery (ISICA) and (or) middle cerebral artery (MCA) stenoses or occlusion showed by digital subtraction angiography (DSA), and reduced cerebral perfusion displayed by CT perfusion (CTP) imaging were retrospectively collected in this study. According to the patient's choice of different treatment methods (STA-MCA bypass and drugs), these patients were allocated into two groups: Bypass group (30 cases) and Drug group (33 cases). Postoperative symptoms, anastomotic patency and hemodynamics were observed in the Bypass group. Post-treatment ischemic events and clinical outcomes were recorded in the two groups and were compared between the two groups.Results: In the Bypass group, DSA all showed anastomotic patency in 28 patients (93.3%, 28/30), and the improvement rate of CTP was all significantly higher in the patients with stage-III CTP than in the patients with stage-II CTP at post-operative 3 days and 6 months (95% vs 60%). Post-treatment ischemic event incidence (13.3% vs 48.5%) and annual stroke rate (6.7% vs 25.6%) were significantly lower in the Bypass group than in the Drug group (All P < 0.05). Pre-treatment National Institutes of Health Stroke Scale (NIHSS) score and Modified Rankin Scale (MRS) score were not significantly different between the two groups, but the NIHSS (2.87 +/- 0.19 and 2.4 +/- 0.19 vs 4.03 +/- 0.47 and 3.97 +/- 0.49) and MRS (1.13 +/- 0.09 and 1.0 +/- 0.07 vs 1.55 +/- 0.14 and 1.52 +/- 0.15) all were significantly lower in the Bypass group than in the Drug group at post-treatment 6 and 24 months (all P < 0.05).Conclusion: STA-MCA bypass can improve cerebral blood perfusion and reduce the incidence of stroke in the patients who have ISICA and (or) MCA-related symptoms, 70%-100% of stenosis, and above stage-ICTP. However, this conclusion remains to be further confirmed.