Takahashi Jun C
Department of Neurosurgery, Kindai University Faculty of Medicine.
No Shinkei Geka. 2022 Jul;50(4):788-796. doi: 10.11477/mf.1436204622.
Complications of the superficial temporal artery-middle cerebral artery(STA-MCA)bypass procedure include skin necrosis, MCA vessel wall injury, and thrombotic occlusion of the anastomotic site. First, deprivation of the STA per se induces ischemia of the skin flap. Skin incisions must be designed carefully to avoid isolating some areas from the blood supply. Secondly, the MCA walls can be extremely thin in moyamoya disease; therefore, the fragile vascular walls must be manipulated gently. The MCA walls should not be grasped directly by forceps. Thirdly, intraluminal thrombi can develop after the completion of the anastomosis. Heparin should be administered intravenously as soon as possible when intraluminal thrombi are detected, followed by aspirin loading via a nasogastric tube. Platelet(white)thrombi are fragile and easily disrupted with mechanical vibration. It is essential to treat them before they develop into a large, firm fibrin thrombus that completely occludes the anastomotic site, which would require suture cutting and surgical thrombus removal.
颞浅动脉-大脑中动脉（STA-MCA）搭桥手术的并发症包括皮肤坏死、大脑中动脉血管壁损伤以及吻合部位的血栓形成。首先，颞浅动脉本身的血供中断会导致皮瓣缺血。必须精心设计皮肤切口，以避免某些区域与血供隔离。其次，烟雾病患者的大脑中动脉血管壁可能极其薄弱；因此，必须轻柔地操作脆弱的血管壁。不应直接用镊子夹持大脑中动脉血管壁。第三，吻合完成后管腔内可能形成血栓。一旦检测到管腔内血栓，应尽快静脉注射肝素，随后经鼻胃管给予负荷剂量的阿司匹林。血小板（白色）血栓很脆弱，容易因机械振动而破裂。在它们发展成完全阻塞吻合部位的大而坚实的纤维蛋白血栓之前进行治疗至关重要，因为后者需要切开缝线并手术清除血栓。
