Abstract：
BACKGROUND: Conventionally, one branch of the superficial temporal artery (STA) is utilized to revascularize the middle cerebral artery (MCA). However, there is the possibility of utilizing both branches of the STA when performing the bypass, characterizing the double-barrel (DB) STA-MCA bypass. Notably, a lack of studies evaluating this technique led the authors to conduct a systematic review and single-arm meta-analysis.
METHODS: PubMed, Embase and Web of Science were searched systematically for publications of DB-STA-MCA bypass on November 1st, 2023. The findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Case reports were not included for statistical analysis purposes.
RESULTS: The review included 408 patients and 534 bypasses from 34 studies. The main etiology was Moyamoya disease (64.6%), followed by cerebral ischemia (22.2%) and aneurysms (12.5%). The median of the mean follow-ups of each study was 12.8 months (range 1.5-87.9). The postoperative patency was 100%. The follow-up patency was 98% (95% CI: 96%-100%; I2 = 0%). The procedure-related mortality was 0% (95% CI: 0%-1%; I2 = 0%). Aneurysms obtained 87% (95% CI: 72%-100%; I2 = 4%) of good clinical outcomes, while Moyamoya disease yielded a rate of 70% (95% CI: 10%-100%; I2 = 97%). Ischemic complications occurred at a rate of 6% (95% CI: 2%-11%; I2 = 36%), while hemorrhagic occurred at 6% (95% CI: 1%-11%; I2 = 56%). Hyperperfusion syndrome rate was calculated as 18% (7%-30%; I2 = 55%) for Moyamoya disease.
CONCLUSIONS: The procedure appears to be safe, with excellent patency rates. The clinical efficacy for ischemic and Moyamoya diseases warrants further standardized robust investigation with a broader number of patients, and aneurysm studies are required to enhance sample sizes. The main complication for the Moyamoya subgroup is hyperperfusion syndrome.
METHODS: PubMed, Embase and Web of Science were searched systematically for publications of DB-STA-MCA bypass on November 1st, 2023. The findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Case reports were not included for statistical analysis purposes.
RESULTS: The review included 408 patients and 534 bypasses from 34 studies. The main etiology was Moyamoya disease (64.6%), followed by cerebral ischemia (22.2%) and aneurysms (12.5%). The median of the mean follow-ups of each study was 12.8 months (range 1.5-87.9). The postoperative patency was 100%. The follow-up patency was 98% (95% CI: 96%-100%; I2 = 0%). The procedure-related mortality was 0% (95% CI: 0%-1%; I2 = 0%). Aneurysms obtained 87% (95% CI: 72%-100%; I2 = 4%) of good clinical outcomes, while Moyamoya disease yielded a rate of 70% (95% CI: 10%-100%; I2 = 97%). Ischemic complications occurred at a rate of 6% (95% CI: 2%-11%; I2 = 36%), while hemorrhagic occurred at 6% (95% CI: 1%-11%; I2 = 56%). Hyperperfusion syndrome rate was calculated as 18% (7%-30%; I2 = 55%) for Moyamoya disease.
CONCLUSIONS: The procedure appears to be safe, with excellent patency rates. The clinical efficacy for ischemic and Moyamoya diseases warrants further standardized robust investigation with a broader number of patients, and aneurysm studies are required to enhance sample sizes. The main complication for the Moyamoya subgroup is hyperperfusion syndrome.
摘要：
背景：通常，颞浅动脉（STA）的一个分支用于对大脑中动脉（MCA）进行血运重建。然而,有可能在执行旁路时利用STA的两个分支，表征双桶(DB)STA-MCA旁路。值得注意的是,由于缺乏评估该技术的研究,作者进行了系统评价和单臂荟萃分析.
方法：PubMed，Embase和WebofScience于11月1日系统地搜索了DB-STA-MCA旁路的出版物，2023年。根据系统审查和荟萃分析（PRISMA）指南的首选报告项目报告研究结果。病例报告未纳入统计分析目的。
结果：该综述包括来自34项研究的408例患者和534例患者。主要病因为烟雾病(64.6%),其次是脑缺血(22.2%)和动脉瘤(12.5%)。每个研究的平均随访中位数为12.8个月（范围1.5-87.9）。术后通畅率为100%。随访通畅率为98%(95%CI:96%-100%;I2=0%)。手术相关死亡率为0%(95%CI:0%-1%;I2=0%)。动脉瘤获得了87%(95%CI:72%-100%;I2=4%)的良好临床结果,而烟雾病的发生率为70％（95％CI：10％-100％；I2=97％）。缺血性并发症发生率为6%(95%CI:2%-11%;I2=36%),而出血发生率为6%(95%CI:1%-11%；I2=56%)。烟雾病的高灌注综合征发生率为18％（7％-30％；I2=55％）。
结论：该程序似乎是安全的，具有出色的通畅率。缺血性和烟雾病的临床疗效需要对更多患者进行进一步标准化的稳健调查，和动脉瘤研究需要增加样本量。烟雾亚组的主要并发症是高灌注综合征。
方法：PubMed，Embase和WebofScience于11月1日系统地搜索了DB-STA-MCA旁路的出版物，2023年。根据系统审查和荟萃分析（PRISMA）指南的首选报告项目报告研究结果。病例报告未纳入统计分析目的。
结果：该综述包括来自34项研究的408例患者和534例患者。主要病因为烟雾病(64.6%),其次是脑缺血(22.2%)和动脉瘤(12.5%)。每个研究的平均随访中位数为12.8个月（范围1.5-87.9）。术后通畅率为100%。随访通畅率为98%(95%CI:96%-100%;I2=0%)。手术相关死亡率为0%(95%CI:0%-1%;I2=0%)。动脉瘤获得了87%(95%CI:72%-100%;I2=4%)的良好临床结果,而烟雾病的发生率为70％（95％CI：10％-100％；I2=97％）。缺血性并发症发生率为6%(95%CI:2%-11%;I2=36%),而出血发生率为6%(95%CI:1%-11%；I2=56%)。烟雾病的高灌注综合征发生率为18％（7％-30％；I2=55％）。
结论：该程序似乎是安全的，具有出色的通畅率。缺血性和烟雾病的临床疗效需要对更多患者进行进一步标准化的稳健调查，和动脉瘤研究需要增加样本量。烟雾亚组的主要并发症是高灌注综合征。
