颞浅动脉-大脑中动脉搭桥术治疗大脑中动脉狭窄或闭塞16例疗效分析

目的:探讨颞浅动脉-大脑中动脉(STA-MCA)搭桥术治疗伴大脑中动脉狭窄或闭塞的缺血性卒中患者的效果。方法:伴大脑中动脉狭窄或闭塞的缺血性卒中患者16例,行STA-MCA搭桥术或STA-MCA搭桥术联合脑-硬脑膜-动脉贴敷(EDAS);术中采用脑血管吲哚菁绿荧光造影、术后行血管超声以确定吻合血管通畅情况;术前、术后1周及出院3个月后采用改良Rankin量表(mRS)对患者进行神经功能评分,随访3个月。结果:所有病例手术均顺利完成;吻合口处血流通畅者15例(93.75%),血流缓慢者1例(6.25%);无患者再发缺血性卒中;术前1周、术后1周及3个月mRS评分良好的患者分别为6例(37.50%)、7例(43.75%)、14例(87.50%);3月时mRS评分良好的患者例数高于术前和术后1周者(P=0.0091,P=0.0233)。结论:STA-MCA搭桥术或联合EDAS治疗大脑中动脉狭窄或闭塞所致脑组织的低灌注效果满意。

STA-MCA Bypass Grafting in the Treatment of Middle Cerebral Artery Stenosis or Occlusion in 16 Patients

Objective: To evaluate the therapy efficacy of superficial temporal artery-middle cerebral artery(STA-MCA) bypass grafting treatment for ischemic stroke patients with severe middle cerebral artery stenosis or occlusion.Methods: A total of 16 patients with ischemic strokes due to severe middle cerebral artery stenosis or occlusion were treated with STA-MCA bypass grafting or combined with encephalo-duro-arterio-synangiosis(EDAS).Revascularization was evaluated using indocyanine green fluorescence angiography and vascular ultrasound.All patients were follow-up for 3 months.Modified Rankin scale(mRS) was used to evaluate the neurologic function of the patients at 1 week before,1 week and 3 months after the treatment.Results: All operations were successfully performed on the patients.Velocity of blood flow in 15 patients(93.75%) was normal,while slow velocity of blood flow was found only in one patient(6.25%).There was no documentation of recurrence of ischemic strokes in 3 months follow-up.According to the scores of mRS,the number of patient with good outcome at 1 week before,1 week and 3 months after the treatment was 6(37.50%),7(43.75%) and 14(87.50%) respectively.The number of patients with good outcome at 3 months after the treatment was significantly higher than those at 1 week before and after treatment(P=0.0091,P=0.0233).Conclusion: STA-MCA bypass grafting or STA-MCA bypass grafting combined with EDAS is effective for ischemic stroke due to severe middle cerebral artery stenosis or occlusion.