Effects of superficial temporal artery-middle cerebral artery bypass on hemodynamics and clinical outcomes in the patients with atherosclerotic stenosis in the intracranial segment of internal carotid artery and middle cerebral artery

• Published in: Clinical neurology and neurosurgery Vol. 186; p. 105510
• Main Authors: Ning, Xin-jie, Gao, Qun, Chen, Chuan, Ling, Cong, Liang, Jia-ji, Li, Zhang-yu, Wang, Hui
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.11.2019; Elsevier Limited
• Subjects: Age; Angiography; Arteriosclerosis; Aspirin; Atherosclerosis; Carotid arteries; Carotid artery; Cerebral artery stenosis; Cerebral blood flow; Clinical outcomes; Computed tomography; Drug therapy; Hemodynamics; Ischemia; Ischemic stroke; Medical imaging; Metabolism; Neurology; Neurosurgery; Patients; Perfusion; Statistical analysis; Stenosis; Stroke; Substance abuse treatment; Superficial temporal artery-middle cerebral artery bypass; Tomography; Veins & arteries; Superficial temporal artery-middle cerebral artery bypass; Cerebral artery stenosis; Ischemic stroke; Atherosclerosis
• ISSN: 0303-8467; 1872-6968; 1872-6968
• DOI: 10.1016/j.clineuro.2019.105510

•STA-MCA bypass improve cerebral blood flow perfusion and reduce stroke.•In the improvement rate of CTP, Stage III patients more markedly improve than Stage II.•STA-MCA bypass is an effective treatment of intracranial segment of IC.•It was proven effective in a strict screen patient retrospective study. To observe the effects of superficial temporal artery-middle cerebral artery bypass (STA-MCA bypass) on hemodynamics and clinical outcomes in the patients with atherosclerotic stenosis in the intracranial segment of internal carotid artery and (or) middle cerebral artery. The data of 63 patients who had the symptoms of cerebral ischemia in recent 3 months, intracranial segment of internal carotid artery (ISICA) and (or) middle cerebral artery (MCA) stenoses or occlusion showed by digital subtraction angiography (DSA), and reduced cerebral perfusion displayed by CT perfusion (CTP) imaging were retrospectively collected in this study. According to the patient's choice of different treatment methods (STA-MCA bypass and drugs), these patients were allocated into two groups: Bypass group (30 cases) and Drug group (33 cases). Postoperative symptoms, anastomotic patency and hemodynamics were observed in the Bypass group. Post-treatment ischemic events and clinical outcomes were recorded in the two groups and were compared between the two groups. In the Bypass group, DSA all showed anastomotic patency in 28 patients (93.3%, 28/30), and the improvement rate of CTP was all significantly higher in the patients with stage-III CTP than in the patients with stage-II CTP at post-operative 3 days and 6 months (95% vs 60%). Post-treatment ischemic event incidence (13.3% vs 48.5%) and annual stroke rate (6.7% vs 25.6%) were significantly lower in the Bypass group than in the Drug group (All P < 0.05). Pre-treatment National Institutes of Health Stroke Scale (NIHSS) score and Modified Rankin Scale (MRS) score were not significantly different between the two groups, but the NIHSS (2.87±0.19 and 2.4±0.19 vs 4.03±0.47 and 3.97±0.49) and MRS (1.13±0.09 and 1.0±0.07 vs 1.55±0.14 and 1.52±0.15) all were significantly lower in the Bypass group than in the Drug group at post-treatment 6 and 24 months (all P < 0.05). STA-MCA bypass can improve cerebral blood perfusion and reduce the incidence of stroke in the patients who have ISICA and (or) MCA-related symptoms, 70%-100% of stenosis, and above stage-ⅠCTP. However, this conclusion remains to be further confirmed.