高流量颅外-颅内分流术与缺血性卒中的显著风险相关。这项研究的目的是评估高流量旁路术之前的STA-MCA旁路术的有效性,作为在其他无法治疗的动脉瘤患者的高流量旁路吻合术期间保护脑缺血的一种手段。
这项前瞻性研究包括2016年6月至2018年1月期间使用STA-MCA旁路术和高流量EC-IC旁路术治疗复杂/巨大动脉瘤的10例连续患者,当时估计经典血管内或显微外科手术排除太危险。早期颅多普勒,MRI,CT扫描,对每位患者进行常规血管造影以确认旁路的通畅性,测量吻合口的流量,检测任何缺血性病变,并评估动脉瘤的排除。
治疗时的平均年龄为55岁(范围为34至67岁)。显微外科手术的平均时间为11小时(范围9至12)。在所有患者中,术中高流量旁路通畅,动脉瘤完全闭塞.早期MRI未见缺血性病变。一名患者在显微外科手术后10天死于与颈总动脉夹层有关的大半球梗塞,另一名患者在术后立即发现硬膜外血肿。
在这项研究中,我们描述了保护性STA-MCA旁路的使用,在高流量旁路之前执行,为了降低围手术期缺血性病变的风险,而不增加外科手术的发病率。这种治疗模式在所有10例患者中都是可行的,没有与STA-MCA吻合相关的并发症。
High-flow extracranial-intracranial bypass is associated with a significant risk of ischemic stroke. The goal of this study is to evaluate the effectiveness of STA-MCA bypass preceding a high-flow bypass as a means of protecting the brain from ischemia during the high-flow bypass anastomosis in patients with otherwise untreatable aneurysms.
This prospective study included 10 consecutive patients treated for complex/giant aneurysm using a previous combined STA-MCA bypass and high-flow EC-IC bypass between June 2016 and January 2018 when classical endovascular or microsurgical exclusion was estimated too risky. Early cranial Doppler, MRI, CT scan, and conventional angiography were performed in each patient to confirm patency of bypasses, measure flow in the anastomoses, detect any ischemic lesions, and evaluate exclusion of the aneurysm.
The mean age at treatment was 55 years (range 34 to 67). The mean time of microsurgical procedure was 11 h (range 9 to 12). In all patients, the high-flow bypass was patent intraoperatively and complete occlusion of aneurysm was obtained. No ischemic lesions were noted on early MRI. One patient died from a large hemispheric infarction related to a common carotid artery dissection 10 days after the microsurgical procedure and immediate postoperative epidural hematoma was noted in one other patient.
In this study, we described the use of a protective STA-MCA bypass, performed prior to the high-flow bypass, in order to reduce the risk of perioperative ischemic lesions without increasing the morbidity of the surgical procedure. This treatment paradigm was feasible in all ten patients without complications related to the STA-MCA anastomosis.