The First Affiliated Hospital, Health Science Center, Ningbo University, Ningbo, China.
Department of Neurosurgery, Ningbo Key Laboratory of Nervous System and Brain Function, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China.
Acta Neurochir (Wien). 2024 Jul 23;166(1):303. doi: 10.1007/s00701-024-06194-9.
STA-MCA bypass surgery is mainly used for Moyamoya disease, giant intracranial aneurysms, and resection of intracranial tumors requiring sacrifice of blood vessels. The intraoperative patency of the reconstructive vessels is critical to the efficacy of the procedure. This study aimed to evaluate the efficacy of intra-arterially infused tirofiban for the treatment of acute thrombosis during STA-MCA bypass surgery and countermeasures for acute thrombosis.
This study involved 209 patients (272 hemispheres) who underwent STA-MCA surgery between November 2020 and December 2023. Intraoperative acute thrombosis occurred in eight patients (3.83%,8 hemispheres). We retrospectively reviewed the clinical and imaging data, surgical procedure, and follow-up outcomes of eight patients. We implemented the different thrombolytic methods to evaluate the optimal thrombosis management during the bypass surgery. After three months, we assessed neurological functions using the modified Rankin Scale (mRS) and conducted a literature review using PubMed.
Eight patients (four male patients and four female patients) developed acute thrombosis during the bypass surgery. Of the eight patients, two underwent re-anastomosis after thrombus removal, three received local injections of tirofiban into the anastomosis or the branches of the superficial temporal artery, and three underwent superselective intra-arterial tirofiban infusion using a microcatheter. Thrombosis were resolved, and arteries were recanalized in all patients. The mRS score was 0 in all patients. No major ischemic or hemorrhagic complications occurred.
Our treatment methods were efficacious in the management of acute thrombosis. Intra-arterial tirofiban administration seems to be a simple and effective treatment option for acute thrombosis during STA-MCA bypass surgery.
颞浅动脉-大脑中动脉（STA-MCA）搭桥术主要用于烟雾病、巨大颅内动脉瘤和需要牺牲血管的颅内肿瘤切除。重建血管的术中通畅性对手术疗效至关重要。本研究旨在评估术中经动脉内滴注替罗非班治疗 STA-MCA 搭桥术急性血栓形成的疗效及急性血栓形成的对策。
本研究纳入 209 例（272 侧）于 2020 年 11 月至 2023 年 12 月期间行 STA-MCA 手术的患者。8 例患者（3.83%，8 侧）发生术中急性血栓形成。回顾性分析 8 例患者的临床和影像学资料、手术过程及随访结果。我们实施了不同的溶栓方法来评估旁路手术中最佳的血栓管理。术后 3 个月，采用改良 Rankin 量表（mRS）评估神经功能，并在 PubMed 上进行文献复习。
8 例患者（4 例男性，4 例女性）在旁路手术中发生急性血栓形成。8 例患者中，2 例血栓取出后行再次吻合，3 例于吻合口或颞浅动脉分支局部注射替罗非班，3 例采用微导管行超选择性动脉内替罗非班滴注。所有患者血栓均溶解，动脉再通。所有患者的 mRS 评分为 0。无严重缺血或出血并发症发生。
我们的治疗方法对急性血栓形成的处理是有效的。动脉内给予替罗非班似乎是治疗 STA-MCA 搭桥术急性血栓形成的一种简单、有效的治疗选择。
