Superficial Temporal Artery to Middle Cerebral Artery Cranial Bypass for Nonmoyamoya Steno-Occlusive Disease in Patients Who Failed Optimal Medical Treatment: A Case Series

被引：11

作者：

Haynes, Joseph ^{[1
]}

Kronenburg, Annick ^{[2
]}

Raz, Eytan ^{[3
]}

Rostanski, Sara ^{[4
]}

Yaghi, Shadi ^{[4
]}

Ishida, Koto ^{[4
]}

Shapiro, Maksim ^{[3
]}

Nelson, Peter Kim ^{[3
]}

Tanweer, Omar ^{[5
]}

Langer, David J. ^{[6
]}

Riina, Howard A. ^{[5
]}

Eichel, Roni ^{[7
]}

Nossek, Erez ^{[5
]}

机构：

[1] Univ Rochester, Sch Med & Dent, Rochester, NY USA

[2] Univ Med Ctr Utrecht, UMC Utrecht Brain Ctr, Dept Neurol & Neurosurg, Utrecht, Netherlands

[3] NYU Langone Hlth, Dept Radiol, Sect Neurointervent Radiol, New York, NY 10016 USA

[4] NYU Langone Hlth, Dept Neurol, New York, NY 10016 USA

[5] NYU Langone Hlth, Dept Neurosurg, 5301st Ave,Ste 8S, New York, NY 10016 USA

[6] Hofstra Northwell, Dept Neurosurg, Lenox Hill Hosp, Zucker Sch Med, New York, NY USA

[7] Hebrew Univ Jerusalem, Shaare Zedek Med Ctr, Dept Neurol, Affiliated Teaching Hosp,Med Fac, Jerusalem, Israel

来源：

OPERATIVE NEUROSURGERY | 2021年 / 20卷 / 05期

关键词：

Bypass; Cerebral revascularization surgery; Extracranial-intracranial bypass; Middle cerebral artery; Superficial temporal artery; EXTRACRANIAL-INTRACRANIAL BYPASS; INDIRECT REVASCULARIZATION; STA-MCA; SURGERY; OUTCOMES;

D O I：

10.1093/ons/opaa458

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND: In the post-Carotid Occlusion Surgery Study (COSS) era, multiple reviews suggested subset groups of patients as potential candidates for superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Among them are patients with recurrent strokes despite optimal medical therapy. There is a paucity of data on the outcome of bypass in these specific patients. OBJECTIVE: To examine the safety and efficacy of direct STA-MCA bypass in patients with nonmoyamoya, symptomatic steno-occlusive disease with impaired distal perfusion, who failed optimal medical management or endovascular treatment. METHODS: A retrospective review was performed to identify patients with cerebrovascular steno-occlusive disease who underwent bypass after symptomatic recurrent or rapidly progressive strokes, despite optimal conservative or endovascular treatment. RESULTS: A total of 8 patients (mean age 60 +/- 6 yr) underwent direct or combined direct/indirect STA-MCA bypass between 2016 and 2019. All anastomoses were patent. One bypass carried slow flow. There were no procedure-related permanent deficits. One patient developed seizures which were controlled by medications. A total of 7 out of 8 patients were stable or improved clinically at last follow-up (mean 27.3 +/- 13.8 mo) without recurrent strokes. One patient did not recover from their presenting stroke, experienced severe bilateral strokes 4 mo postoperatively, and subsequently expired. Modified Rankin Scale (mRS) improved in 6 patients (75%), remained stable in 1 patient (12.5%), and deteriorated in 1 (12.5%). Good long-term functional outcome was achieved in 5 patients (63%, mRS <= 2). CONCLUSION: Patients with symptomatic, hypoperfused steno-occlusive disease who fail optimal medical or endovascular treatment may benefit from cerebral revascularization. Direct or combined STA-MCA bypass was safe and provided favorable outcomes in this small series.

引用

页码：444 / 455

页数：12

共 26 条

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