大动脉粥样硬化型缺血性脑血管病的搭桥手术策略

目的探讨颞浅动脉-角回动脉搭桥术（STA—AAGbypass）治疗大动脉粥样硬化型缺血性脑血管病的策略。方法回顾性分析2010年1月～2013年6月9例实施颞浅动脉-角回动脉搭桥术的大动脉粥样硬化型缺血性脑血管病患者的资料。包括术前及术后数字减影血管造影（DSA）显示的脑血管情况、计算机断层扫描灌注成像（CTP）显示的脑血流动力学情况、术中所见、随访结果。结果术前DSA显示颈内动脉和（或）大脑中动脉粥样硬化性重度狭窄和（或）闭塞，后循环和（或）颈外动脉和（或）对侧前循环部分代偿，术中多普勒检测颞浅动脉-角回动脉吻合处血流通畅。术后DSA示颞浅动脉-角回动脉吻合通畅，CTP各项参数较术前明显改善。随访3～20个月，无新发脑缺血事件及死亡。结论颞浅动脉-角回动脉搭桥术是治疗大动脉粥样硬化型缺血性脑血管病的有效方法．术前及术后需DSA全面评估颅内外血管情况及CTP评估脑血流动力学情况，可取得良好效果。

Strategy of microsurgery on patients with atherosclerotic ischemic cerebrovascular disease of large artery

Objective To investigate the strategy of superficial temporal artery-artery of angular gyms bypass （STA-AAG bypass） on patients with atherosclerotic ischemic cerebrovascular disease of large artery. Methods Nine cases of atherosclerotic ischemic cerebrovascular disease of large artery treated with STA-AAG bypass from January 2010 to June 2013 were analysed retrospectively, their preoperative and postoperative conditions of cerebrovascular disease were examined by digital subtraction angiography （DSA）, the cerebral hemodynamics were examined by computer to- mography perfusion （CTP）,and the intraoperative findings as well as outcomes were analyzed. Results Preoperative DSA revealed that the internal carotid artery （ICA）and （or） the middle cerebral artery （MCA）were obviously stenotie and （or） occlusive resulting from artherosclerosis, posterior circulation and （or） external carotid artery and （or） con- tralateral anterior circulation partly compensate. Intraoperative Doppler detected the blood flow of stoma of STA and AAG was unobstructed. Postoperative DSA showed the anastomosis was successful, the parameters of CTP was better than that before the operation. All the patients were followed up from 3 to 20 months,there was no ischemic event and death. Conclusion STA-AAG bypass is an effective method for the treatment of large artery atherosclerotic ischemic cerebrovascular disease, The key to the operation is the preoperative and postoperative assessment of DSA and CTP, and good results can be obtained.