颞浅动脉-大脑中动脉搭桥术治疗动脉粥样硬化性脑缺血13例报告

目的 探讨颞浅动脉-大脑中动脉搭桥术（superficial temporal artery-middle cerebral artery bypass，STA-MCA bypass）治疗动脉粥样硬化性脑缺血的疗效。方法 对北京天坛医院进行STA-MCA bypass治疗的13例经计算机断层扫描灌注成像（computertomography perfusion，CTP）评价存在低灌注的颈内动脉和（或）大脑中动脉粥样硬化性重度狭窄和（或）闭塞患者进行回顾性研究。通过手术中脑血管吲哚菁绿荧光造影和手术后数字减影血管造影（digital subtraction angiography，DSA）、计算机断层扫描血管成像（computer tomography angiography，CTA）等确定吻合血管通畅程度。比较手术前、后美国国立卫生研究院卒中量表（National Institutes ofHealth Stroke Scale，NIHSS）评分、改良的Rankin量表（modified Rankin Scale，mRS）评分及CTP参数值。结果 13例患者中，男11例、女2例，11例行STA-MCA bypass，2例行STA-MCA bypass联合脑-硬脑膜-动脉贴敷术，吻合血管血流通畅。手术后3个月mRS评分较术前下降（0.92±0.76 vs 2.38±1.26，P =0.001）。手术侧比非手术侧MCA供血区域CTP参数绝对值的比较，手术前和术后15 d内相对脑血流量（relative cerebral blood flow，RCBF）、相对平均通过时间（relative mean transit time，RMTT）及相对达峰时间（relative time to peak，RTTP）分别为0.71±0.13 vs 1.00±0.25、2.53±1.32 vs 1.48±0.94和1.20±0.11 vs 1.07±0.12，P =0.002、0.036和0.015）。手术后3～10个月RTTP较术前下降（1.10±0.96vs 1.22±0.82，P =0.043）。13例患者在随访期间无死亡、无新的脑缺血事件发生。结论 对于CTP评价存在低灌注的动脉粥样硬化性脑血管重度狭窄或闭塞患者，STA-MCA bypass可能能够改善低灌注状态、减少缺血症状发作及预防卒中再发生；CTP可能成为简单可靠并有推广价值的评价手段。

Superficial Temporal Artery-middle Cerebral Artery Bypass for the Treatment of Ischemic Atherosclerotic Disease-a Report of Thirteen Cases

Objective To assess the effectiveness of superficial temporal artery-middle cerebral artery bypass for the treatment of symptomatic ischemic atherosclerotic disease. Methods Thirteen patients with symptomatic ischemic atherosclerotic disease at Beijing Tiantan Hospital were treated with superficial temporal artery-middle cerebral artery bypass. Neurological status and computer tomography perfusion were evaluated before and after bypass. The bypass patency were detected by indocyanine green angiography in operation and digital subtraction angiography （DSA） or computer tomography angiography （CTA） after operation. Results Eleven patients underwent superficial temporal artery to middle cerebral artery bypass （STA-MCA bypass） and 2 patients underwent superficial temporal artery to middle cerebral artery anastomosis combined with encephalo-duro-arterio-synangiosis （EDAS）. The modified Rankin Scale （mRS） revealed statistically significant difference between preoperation and 3 months after surgery （0.92±0.76 vs 2.38±1.26, P=0.001）. In the early postoperation, significant changes in relative cerebral blood flow （0.7 l±0.13 vs 1.00＆0.25, P=0.002）, relative mean transit time （2.53± 1.32 vs 1.48±0.94, P=0.036） and relative time to peak （1.20±0.11 vs 1.07±0.12, P=0.015） were seen. Significant changes （P〈0.05） in relative time to peak （1.10：60.96 vs 1.22±0.82, P=0.043） was also seen in the late postoperation. There was no recurrence of transient ischemic attack or cerebral infarcation during a mean follow-up of 9.5 months. Conclusion For patients who have symptomatic atherosclerotic disease with hemodynamic compromise, STA-MCA bypass may improve cerebral hemodynamics and prevent stroke. Computer tomography perfusion may become an effective and general method to assess cerebral perfusion.