烟雾病患者自发性颈外动脉颅内代偿的影响因素及与血管融通术后血管重建的关系

目的探讨烟雾病患者自发性颈外动脉向颅内代偿形成的影响因素及其与硬脑膜动脉血管融通术（EDAS）后血管重建效果的关系。方法回顾性分析74例行EDAS的烟雾病患者的临床资料，分析自发性颈外动脉向颅内代偿途径；评估性别、年龄、发病类型，术前是否存在脑梗死、脑糖代谢异常及铃木分期对颈外动脉向颅内代偿的影响。术后采用DSA评估血管重建的效果，参照松岛分级方法，分析有无自发性颈外动脉向颅内代偿，对EDAS术后血管重建效果的影响。结果①74例148侧大脑半球中，左侧有代偿的50例（67．6％），右侧有42例（56．8％），差异无统计学意义。②参与代偿的血管中，单支的占73．9％，2支的占23．9％，3支的占2．2％；脑膜中动脉占50％，颞浅动脉占14．2％，枕动脉占13．2％，上颌动脉占3．4％。③多因素分析显示，术前铃木分期是自发性颈外动脉向颅内代偿形成的独立影响因素（95％CI：-0．6298～-0．0346，Z值=-2．19；P=0．0287）；随着铃木分期级别的增高，形成代偿的概率逐渐增高。性别、年龄、发病类型、脑梗死、脑糖代谢异常对代偿形成无明显影响。④术后随访3～55个月。有代偿组血管重建效果优于无代偿组，差异有统计学意义（P〈0．01）。在松岛分级0～1级的血管重建患者中，有代偿组所占的比例低于无代偿组（0级：13．04％比35．71％；1级：13．04％比25．00％）；有代偿组3级的患者所占的比例高于无代偿组（48．9％比14．29％）。结论术前铃木分期是颈外动脉向颅内代偿形成的独立影响因素，自发性颈外动脉向颅内代偿是影响EDAS术后血管重建效果的因素之一。

Relationship between the influential factors of spontaneous intracranial compensation from external carotid artery and the revascularization after encephalo-duro-arterio-synangiosis in patients with moyamoya disease

Objective To investigate the relationship between the influential factors of spontaneous intracranial compensation from external carotid artery （ECA） and the effect of revascularization after encephalo-duro-arterio-synangiosis （EDAS） in patients with moyamoya disease. Methods The clinical data of 74 patients with moyamoya disease underwent EDAS were analyzed retrospectively. The spontaneous intracranial compensatory pathways from ECA were analyzed. The sex, age, type of disease （ ischemic and hemorrhagic）, whether presence of cerebral infarction before surgery, the cerebral glucose metabolic abnormalities, and the effect of preoperative Suzuki stage on the intracranial compensation from ECA were evaluated. The effect of revascularization was evaluated postoperatively with DSA. The effect of intracranial compensation from ECA on the revascularization after EDAS was analyzed. Results （1）Of the 74 patients （148 hemispheres）, 50 hemispheres （67.6%） had compensation on the left sides and 42 （56.8%） on the right sides. （2）The blood vessels involved in compensation in one, two and three branches accounted for 73.9% , 23.9% and 2.2% , respectively. The middle meningeal artery, superficial temporal artery, occipital artery, and maxillary artery was involved for 50% , 14.2% , 13.2% and 3.4%, respectively. （3）The multivariate analysis showed that the preoperative Suzuki stage was an independent influential factor for the formation of spontaneous intracranial compensation from ECA （95% CI, -0. 6298 to -0. 0346, Z value, - 2.19 ; P = 0. 0287 ）. With the increase of staging, the probability of the formation of compensation increased gradually. The sex, age, type of disease, cerebral infarction, and cerebral glucose metabolic abnormalities had no significant influence on compensatory formation. （4）The patients were followed up for 3 to 35 months after surgery. The effect of revascularization in compensatory group was superior to non-compensatory group. The difference was statistically significant （ P 〈 0.01 ）. The patients with revascularization grade 0 to 1 in the proportion of compensatory group was lower than those in the non-compensatory group （grade 0： 13.04% vs. 35.71% ; grade 1 ： 13.04% vs. 25.00% ） ; the patients with grade 3 in the proportion of compensatory group was higher than that in the non-compensatory group （48.9% vs. 14.29% ）. There was no significant difference in patients with grade 2 between the two groups （25.00% vs. 25.00% ）. Conclusion The preoperative Suzuki stage of DSA was an independent influential factor for formation of intracranial compensation from ECA. The spontaneous intracranial compensation from ECA is a factors that affecting the effect of revascularization after EDAS.