PDF(Pubmed)
Abstract：
Since the first description of the possible utilization of the internal maxillary artery for bypass surgery, there are some reports of its use in aneurysm cases; however, there is no information about the possible advantages of this type of bypass for cerebral ischemic disease. We present a 77-year-old man with a history of diabetes, hypertension, systemic atherosclerosis, and two acute myocardial infarctions with left hemiparesis. Imaging studies reported total occlusion of the right internal carotid artery and 75% occlusion on the left side, with an old opercular infarction and repeated transient ischemic attacks in the right middle cerebral artery territory despite medical treatment. After a consensus, we decided to perform a bypass from the internal maxillary artery to the M2 segment of the middle cerebral artery using a radial artery graft. After performing the proximal anastomosis, the calculated graft\'s free flow was 216 ml/min. Subsequently, after completing the bypass, the patency was confirmed with fluorescein videoangiography and intraoperative Doppler. Postoperatively, imaging studies showed improvement in the perfusion values and the hemiparesis from 3/5 to 4+/5. The patient was discharged one week after the operation, with a modified Rankin scale of 1, without added deficits. The use of revascularization techniques in steno-occlusive disease indicates a select group of patients that may benefit from this procedure. In addition, internal maxillary artery bypass has provided a safe option for large areas of ischemia that cannot be supplied with a superficial temporal artery - middle cerebral artery bypass.
摘要：
自从第一次描述上颌内动脉可能用于搭桥手术以来，有一些关于它在动脉瘤病例中使用的报道；然而，没有关于这种类型的旁路治疗脑缺血疾病的可能优势的信息。我们介绍了一个77岁的有糖尿病史的男人,高血压,全身性动脉粥样硬化,和两次急性心肌梗塞伴左偏瘫。影像学研究报告右侧颈内动脉完全闭塞，左侧75%闭塞，尽管接受了药物治疗，但右大脑中动脉区域仍有陈旧性手术梗塞和反复的短暂性脑缺血发作。达成共识后,我们决定使用桡动脉移植物从颌内动脉到大脑中动脉M2段进行旁路手术.近端吻合后,计算移植物的自由流量为216ml/min。随后，完成旁路后，通过荧光血管造影和术中多普勒检查证实了通畅。术后,影像学研究显示灌注值和偏瘫从3/5改善至4+/5.患者在手术后一周出院,修改后的兰金量表为1，没有增加赤字。在狭窄闭塞性疾病中使用血运重建技术表明有一组可能受益于该手术的患者。此外,颌内动脉旁路术为不能提供颞浅动脉-大脑中动脉旁路术的大面积缺血提供了安全的选择。
