目的:STA-MCA搭桥手术主要用于烟雾病,巨大的颅内动脉瘤,切除颅内肿瘤需要牺牲血管。重建血管的术中通畅对手术的功效至关重要。本研究旨在评估动脉内输注替罗非班治疗STA-MCA搭桥手术中急性血栓形成的疗效以及急性血栓形成的对策。
方法:这项研究涉及209例患者(272个半球),他们在2020年11月至2023年12月期间接受了STA-MCA手术。术中发生急性血栓8例(3.83%,8半球)。我们回顾了临床和影像学资料,外科手术,8例患者的随访结果。我们实施了不同的溶栓方法,以评估旁路手术期间的最佳血栓形成管理。三个月后,我们使用改良Rankin量表(mRS)评估神经功能,并使用PubMed进行文献综述.
结果:8例患者(4例男性患者和4例女性患者)在搭桥手术中出现急性血栓形成。八个病人中,两人在取栓后接受了重新吻合,3人接受了替罗非班在吻合口或颞浅动脉分支的局部注射,3人使用微导管进行了超选择性动脉内替罗非班输注。血栓缓解了,所有患者的动脉都被再通化。所有患者的mRS评分均为0。无重大缺血或出血并发症发生。
结论:我们的治疗方法对急性血栓形成的治疗是有效的。动脉内替罗非班给药似乎是STA-MCA搭桥手术中急性血栓形成的一种简单有效的治疗选择。
STA-MCA bypass surgery is mainly used for Moyamoya disease, giant intracranial aneurysms, and resection of intracranial tumors requiring sacrifice of blood vessels. The intraoperative patency of the reconstructive vessels is critical to the efficacy of the procedure. This study aimed to evaluate the efficacy of intra-arterially infused tirofiban for the treatment of acute thrombosis during STA-MCA bypass surgery and countermeasures for acute thrombosis.
This study involved 209 patients (272 hemispheres) who underwent STA-MCA surgery between November 2020 and December 2023. Intraoperative acute thrombosis occurred in eight patients (3.83%,8 hemispheres). We retrospectively reviewed the clinical and imaging data, surgical procedure, and follow-up outcomes of eight patients. We implemented the different thrombolytic methods to evaluate the optimal thrombosis management during the bypass surgery. After three months, we assessed neurological functions using the modified Rankin Scale (mRS) and conducted a literature review using PubMed.
Eight patients (four male patients and four female patients) developed acute thrombosis during the bypass surgery. Of the eight patients, two underwent re-anastomosis after thrombus removal, three received local injections of tirofiban into the anastomosis or the branches of the superficial temporal artery, and three underwent superselective intra-arterial tirofiban infusion using a microcatheter. Thrombosis were resolved, and arteries were recanalized in all patients. The mRS score was 0 in all patients. No major ischemic or hemorrhagic complications occurred.
Our treatment methods were efficacious in the management of acute thrombosis. Intra-arterial tirofiban administration seems to be a simple and effective treatment option for acute thrombosis during STA-MCA bypass surgery.