Sundt T M, Whisnant J P, Fode N C, Piepgras D G, Houser O W
Mayo Clin Proc. 1985 Apr;60(4):230-40. doi: 10.1016/s0025-6196(12)60315-2.
Selected patients with acute or continuing ischemic symptoms from occlusions or inaccessible stenotic lesions of the internal carotid artery or middle cerebral artery have been considered candidates for a carotid artery-middle cerebral artery bypass procedure at our institution since July 1974. We report herein an 8-year experience through June 1982 with 415 operations in 403 patients in whom a branch of the superficial temporal artery was anastomosed to a branch of the middle cerebral artery. Patients selected for operation usually had had more than one form of ischemic symptom. The primary indication for operation was transient ischemic attacks, and the most common vascular pathologic condition was internal carotid artery occlusion. Preoperatively, 183 patients were taking antiplatelet agents and 157 were taking anticoagulants. Neurologic function 6 months postoperatively was equal to or better than the function preoperatively in 95% of survivors. The bypass pedicle was patent in 99% of patients studied. The mortality and morbidity associated with the surgical procedure varied on the basis of the patient's preoperative neurologic condition but were 1% and 4%, respectively, for the entire group at 30 days postoperatively. Of the 54 deaths during the entire follow-up period, 27 were cardiogenic and 6 were from ischemic stroke. On the basis of patient-months of follow-up, stroke was 8 times more likely to occur within 6 months after operation than thereafter.
自1974年7月以来，我们机构一直将患有急性或持续性缺血症状、由颈内动脉或大脑中动脉闭塞或难以处理的狭窄病变引起的患者视为颈动脉-大脑中动脉搭桥手术的候选对象。本文报告了截至1982年6月的8年经验，共对403例患者进行了415次手术，其中颞浅动脉的一个分支与大脑中动脉的一个分支进行了吻合。被选做手术的患者通常有不止一种缺血症状形式。手术的主要指征是短暂性脑缺血发作，最常见的血管病理状况是颈内动脉闭塞。术前，183例患者服用抗血小板药物，157例患者服用抗凝剂。95%的存活者术后6个月的神经功能等于或优于术前。在接受研究的患者中，99%的搭桥蒂保持通畅。与手术相关的死亡率和发病率因患者术前神经状况而异，但在术后30天，整个组的死亡率和发病率分别为1%和4%。在整个随访期间的54例死亡病例中，27例为心源性，6例死于缺血性中风。根据患者的随访月数，术后6个月内发生中风的可能性是此后的8倍。
