Yu Zaitao, Yang Yang, Shi Xiang'en, Qian Hai, Liu Fangjun
a Department of Neurosurgery , Fu Xing Hospital, Capital Medical University , Beijing , China.
b Department of Neurosurgery , Sanbo Brain Hospital Capital Medical University , Beijing , China.
Br J Neurosurg. 2017 Dec;31(6):668-671. doi: 10.1080/02688697.2017.1327015. Epub 2017 May 11.
Ischemic cerebrovascular diseases are traditionally treated using an extracranial-intracranial (EC-IC) bypass. The use of the internal maxillary artery (IMA) in the subcranial-intracranial (SC-IC) bypass was recently described as an alternative treatment. However, the haemodynamics of this new approach have not been defined.
The haemodynamic parameters (flow volume [FV], internal diameter [ID], time-averaged mean velocity [TAM], pulsatility index [PI] and resistance index [RI]) of the IMA-radial artery graft (RAG)-middle cerebral artery (MCA) (n = 12) bypass and superficial temporal artery (STA)-MCA bypass (n = 18) were measured using intraoperative duplex ultrasonography and compared.
The FV was 81.36 ± 30.41 (62.05-100.70) ml/min for the IMA-RAG-MCA bypass. This was significantly higher than that of the STA-MCA bypass (27.25 ± 9.32 (22.62-31.88) ml/min; P < .01). The ID and TAM in the IMA-RAG-MCA bypass were higher than in the STA-MCA bypass (P < .01; P < .01). No significant differences were observed in PI (P ≈ .21) and RI (P ≈ .08). The early patency rate (one month after the operation) was 100% for the IMA-RAG-MCA bypass and 94% for the STA-MCA bypass.
The IMA-RAG-MCA bypass provides moderate to high blood flow to the revascularized territory and blood flow was higher by this method than the STA-MCA bypass.
缺血性脑血管疾病传统上采用颅外-颅内（EC-IC）旁路手术进行治疗。最近有描述称，在颅下-颅内（SC-IC）旁路手术中使用上颌内动脉（IMA）作为一种替代治疗方法。然而，这种新方法的血流动力学尚未明确。
采用术中双功超声测量IMA-桡动脉移植物（RAG）-大脑中动脉（MCA）旁路手术（n = 12）和颞浅动脉（STA）-MCA旁路手术（n = 18）的血流动力学参数（血流量[FV]、内径[ID]、时间平均平均流速[TAM]、搏动指数[PI]和阻力指数[RI]），并进行比较。
IMA-RAG-MCA旁路手术的FV为81.36±30.41（62.05 - 100.70）ml/min。这显著高于STA-MCA旁路手术的FV（27.25±9.32（22.62 - 31.88）ml/min；P <.01）。IMA-RAG-MCA旁路手术的ID和TAM高于STA-MCA旁路手术（P <.01；P <.01）。PI（P≈.21）和RI（P≈.08）未观察到显著差异。IMA-RAG-MCA旁路手术的早期通畅率（术后1个月）为100%，STA-MCA旁路手术为94%。
IMA-RAG-MCA旁路手术为血管重建区域提供中到高血流量，且该方法的血流量高于STA-MCA旁路手术。
