颌内动脉(IMAX)在颅内-颅内搭桥术中的应用,用于复杂动脉瘤的血运重建,肿瘤,或难治性缺血显示出希望。然而,缺乏关于其结果的有力证据。因此,作者通过汇总分析进行了系统评价,以阐明该方法的疗效.我们系统地搜索了PubMed,Embase,和WebofScience数据库遵循PRISMA指南。纳入的文章使用IMAX作为供体血管对颅内区域进行血运重建,并报告了以下至少一种结果:通畅,并发症,或临床数据。有利的结果被定义为没有神经缺陷或基线条件的改善。并发症被认为是与手术直接相关的任何不良事件。在418篇检索到的文章中,包括26个,183名患者。其中,119有动脉瘤,41例经历缺血性中风(短暂性或无),2人动脉闭塞,3人患有肿瘤。此外,91.8%的旁路使用桡动脉移植物,87.9%的大脑中动脉血管重建。中位平均随访时间为12个月(0.3~53.1)。术后通畅率为99%(95%CI:97-100%;I2=0%),而随访时的通畅率为82%(95%CI:68-96%;I2=77%)。21%的病例发生并发症(95%CI:9-32%;I2=58%),手术相关死亡率为0%(95%CI:0-2%;I2=0%)。在88%的患者中观察到良好的结果(95%CI:81-96%;I2=0%),只有3%经历了缺血(95%CI:0-6%;I2=0%)。使用IMAX的颅内下转流术显示出出色的术后通畅性和相当有利的临床结果。虽然存在并发症,该程序具有最小的死亡风险。然而,长期通畅表现出异质性的发现,保证额外的研究。
The utilization of the internal maxillary artery (IMAX) in subcranial-intracranial bypass for revascularization in complex aneurysms, tumors, or refractory ischemia shows promise. However, robust evidence concerning its outcomes is lacking. Hence, the authors embarked on a systematic review with pooled analysis to elucidate the efficacy of this approach. We systematically searched PubMed, Embase, and Web of Science databases following PRISMA guidelines. Included articles used the IMAX as a donor vessel for revascularizing an intracranial area and reported at least one of the following outcomes: patency, complications, or clinical data. Favorable outcomes were defined as the absence of neurologic deficits or improvement in the baseline condition. Complications were considered any adverse event directly related to the procedure. Out of 418 retrieved articles, 26 were included, involving 183 patients. Among them, 119 had aneurysms, 41 experienced ischemic strokes (transient or not), 2 had arterial occlusions, and 3 had neoplasia. Furthermore, 91.8% of bypasses used radial artery grafts, and 87.9% revascularized the middle cerebral artery territory. The median average follow-up period was 12 months (0.3-53.1). The post-operation patency rate was 99% (95% CI: 97-100%; I2=0%), while the patency rate at follow-up was 82% (95% CI: 68-96%; I2=77%). Complications occurred in 21% of cases (95% CI: 9-32%; I2=58%), with no significant procedure-related mortality in 0% (95% CI: 0-2%; I2=0%). Favorable outcomes were observed in 88% of patients (95% CI: 81-96%; I2=0%), and only 3% experienced ischemia (95% CI: 0-6%; I2=0%). The subcranial-intracranial bypass with the IMAX shows excellent postoperative patency and considerable favorable clinical outcomes. While complications exist, the procedure carries a minimal risk of mortality. However, long-term patency presents heterogeneous findings, warranting additional research.