Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan.
Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa-ku, Tokyo, Japan.
World Neurosurg. 2022 Aug;164:128-134. doi: 10.1016/j.wneu.2022.04.107. Epub 2022 Apr 30.
Patients with multiple intracranial atherosclerotic stenoses often present with hemodynamic instability in 2 remote regions without a reciprocal vascular network. In this situation, revascularization to each region may be required.
In this report, 2 patients who had coexisting unilateral middle cerebral artery (MCA) and contralateral anterior cerebral artery territory ischemia were treated by using ipsilateral superficial temporal artery (STA)-radial artery graft-contralateral A3 bypass and ipsilateral STA-MCA bypass in one stage.
Postoperatively, the bypass conduit was well established, and the patients' hemodynamic instability was improved.
In patients with severe hemodynamic instability in the remote unilateral MCA and contralateral anterior cerebral artery regions, as in our 2 cases, ipsilateral STA-MCA and ipsilateral STA-radial artery graft-contralateral A3 bypasses in one stage can be a treatment option.
有多发性颅内动脉粥样硬化狭窄的患者常表现为 2 个远隔区域的血流动力学不稳定，而这些区域之间没有相互连通的血管网络。在这种情况下，可能需要对每个区域进行血运重建。
在本报告中，2 例同时存在单侧大脑中动脉（MCA）和对侧大脑前动脉区域缺血的患者，采用同侧颞浅动脉（STA）-桡动脉移植-对侧 A3 旁路和同侧 STA-MCA 旁路一期手术治疗。
术后旁路血管通畅，患者血流动力学不稳定得到改善。
对于严重的单侧 MCA 和对侧大脑前动脉区域血流动力学不稳定的患者，如我们的 2 例患者，同侧 STA-MCA 和同侧 STA-桡动脉移植-对侧 A3 旁路一期手术可能是一种治疗选择。
