Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Internal Medicine, Hematology, University of Miami Miller School of Medicine, Miami, Florida, USA.
World Neurosurg. 2022 Dec;168:e500-e517. doi: 10.1016/j.wneu.2022.10.015. Epub 2022 Oct 7.
Cerebral extracranial-intracranial (EC-IC) direct bypass is a commonly used procedure for the treatment of cerebral hypoperfusion secondary to chronic steno-occlusive vasculopathy. We sought to determine clinical outcomes, intraoperative blood flow analysis, long term follow up, and long term patency rates from a single surgeon's series of direct cerebral bypass for moyamoya disease, moyamoya syndrome, and steno-occlusive disease.
We reviewed clinical, demographic, operative and neuroimaging records for all patients who underwent a direct EC-IC bypass by the senior author between August 1999 and November 2020. Primary outcomes analyzed were functional long-term outcomes (by modified Rankin score [mRS]), surgical complications, and short-term and long-term bypass patency.
A total of 162 revascularization procedures in 124 patients were performed. Mean clinical follow up time was 2 years 11 months. The combined immediate and long term postoperative stroke and/or intracerebral hemorrhage rate was 6.2%. There were 17 bypasses (10%) that were found to be occluded at long-term follow-up, all but one were asymptomatic. Long-term graft occlusion was correlated with presence of complete collateralization on preoperative angiography but not cut flow index (CFI). Overall, patients had a significant clinical improvement with a mean mRS score 1.8 preoperatively and 1.2 postoperatively.
In our consecutive series of patients treated with direct EC-IC cerebral bypass, there was significant improvement in functional outcome as measured by the mRS. The long term patency rate was 90%. There was a statistically significant correlation between complete or incomplete angiographic collateralization patterns and long-term bypass occlusion. There was no correlation between bypass type, clinical syndrome, or CFI and long-term occlusions. The role of bypass surgery and the need for surgical expertise remain strong in the treatment of moyamoya variants and a select group of atherosclerotic steno-occlusive patients.
颅内外（EC-IC）直接旁路搭桥术是治疗慢性狭窄闭塞性血管病引起的脑灌注不足的常用方法。我们旨在确定一位外科医生对烟雾病、烟雾综合征和狭窄闭塞性疾病进行直接脑旁路搭桥术的临床结局、术中血流分析、长期随访和长期通畅率。
我们回顾了 1999 年 8 月至 2020 年 11 月期间由资深作者进行的所有直接 EC-IC 旁路搭桥术患者的临床、人口统计学、手术和神经影像学记录。主要分析的结果是功能长期结局（改良 Rankin 评分[mRS]）、手术并发症以及短期和长期旁路通畅率。
124 例患者共进行了 162 次血管重建手术。平均临床随访时间为 2 年 11 个月。总的即时和长期术后卒中或颅内出血率为 6.2%。在长期随访中发现有 17 个旁路（10%）闭塞，除一个之外均无症状。长期吻合口闭塞与术前血管造影的完全侧支循环存在相关，但与切割血流指数（CFI）无关。总体而言，患者的功能预后有显著改善，术前 mRS 评分均值为 1.8，术后为 1.2。
在我们连续的直接 EC-IC 脑旁路搭桥术患者系列中，mRS 测量的功能结局有显著改善。长期通畅率为 90%。完全或不完全的血管造影侧支循环模式与长期旁路闭塞有统计学显著相关性。旁路类型、临床综合征或 CFI 与长期闭塞之间无相关性。旁路手术的作用和对手术专业知识的需求在烟雾病变异和选择的动脉粥样硬化狭窄闭塞性患者的治疗中仍然很强。
