Wang Zhong-gao, Gu Yong-quan, Zhang Jian, Li Jian-xin, Yu Heng-xi, Luo Tao, Guo Lian-rui, Chen Bing, Li Xue-feng, Qi Li-xing
Vascular Institute, Xuanwu Hospital, Capital University of Medical Sciences, Beijing 100053, China.
Zhonghua Wai Ke Za Zhi. 2006 Jan 1;44(1):14-7.
To explore the management of cerebral ischemia caused by Takayasu's arteritis.
One hundred and three cases treated from 1984 to 2003 were reviewed including 92 females. Seven cases underwent ascending aorta to bilateral internal carotid artery (ICA) bypass, 38 cases to the axillary artery with graft to single ICA bypass. Six cases underwent ascending aorta to axillary bypass with 3 graft to single ICA bypasses as the second stage surgery. Three cases underwent ascending aorta to right ICA bypass with 2 graft to left ICA bypasses as well as 6 subclavian to carotid bypass, PTA in 5 and stenting in 3 cases, etc.
Twenty-seven patients with less clinical severity received conservative therapy, 9 of them had mostly temporarily improvement, 15 had slight improvement or basically no change, 1 had hemiplegia and 2 died of stroke and myocardial infarction respectively. Surgically, the short-term effective rate was 87% and operative death 7.8%. Fifty-five patients were followed up, a mean follow-up time was 48 months, and the follow-up rate was 80.9%. The excellently, good, fair, no change and death rate were 36.4%, 38.2%, 20.0%, 3.6% and 1.8% respectively. All patients with PTA or stent had an immediate good response and all recurred within 3 to 5 months.
For treating severe cerebral ischemia caused by Takayasu's arteritis, the ascending aorta to axillary and single ICA reconstruction or the ascending aorta-bilateral axillary bypass for patients with subclavian steal syndrome is advocated; second stage operation from graft to contralateral ICA can be carried out if necessary.
探讨大动脉炎所致脑缺血的治疗方法。
回顾性分析1984年至2003年治疗的103例患者，其中女性92例。7例行升主动脉至双侧颈内动脉（ICA）搭桥术，38例行腋动脉至单根ICA搭桥术并使用移植物。6例行升主动脉至腋动脉搭桥术，3根移植物至单根ICA搭桥术作为二期手术。3例行升主动脉至右ICA搭桥术，2根移植物至左ICA搭桥术以及6例锁骨下动脉至颈动脉搭桥术，5例行经皮腔内血管成形术（PTA），3例行支架置入术等。
27例临床症状较轻的患者接受保守治疗，其中9例大多有暂时改善，15例有轻微改善或基本无变化，1例出现偏瘫，2例分别死于中风和心肌梗死。手术方面，短期有效率为87%，手术死亡率为7.8%。55例患者进行了随访，平均随访时间为48个月，随访率为80.9%。优良、尚可、一般、无变化及死亡率分别为36.4%、38.2%、20.0%、3.6%和1.8%。所有接受PTA或支架置入术的患者即刻反应良好，但均在3至5个月内复发。
对于治疗大动脉炎所致的严重脑缺血，提倡对锁骨下动脉窃血综合征患者行升主动脉至腋动脉及单根ICA重建术或升主动脉-双侧腋动脉搭桥术；必要时可进行移植物至对侧ICA的二期手术。
