Qiu Cheng, Zhang Yanping, Yu Zhiqiang, Xu Yonghui, Huang Yongjiang, Huang Tianci, Ma Jun, Zhao Jinbing
Nanjing Comprehensive Stroke Center, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, China.
Neurosurgery Department, Affiliated Hospital of Jining Medical University, Jining, China.
Emerg Med Int. 2025 Jan 16;2025:5059097. doi: 10.1155/emmi/5059097. eCollection 2025.
Ischemic stroke is one of the major emergency diseases leading to death and disability worldwide, characterized by its acute onset and the urgent need for prompt medical intervention to reduce mortality and long-term disability. Chronic terminal internal carotid artery and/or middle cerebral artery occlusion (CTI/MCAO) is an important subtype of intracranial artery occlusive disease. The superficial temporal artery-to-MCA (STA-MCA) bypass has been proposed to improve cerebral blood flow (CBF) and cerebrovascular reserve (CVR), potentially enhancing neurological outcomes. However, its safety and efficacy in CTI/MCAO patients remain controversial. A total of 107 CTI/MCAO patients from Nanjing Brain Hospital, enrolled between July 2019 and June 2022, were divided into surgical and medical treatment groups. Cerebral perfusion and collateral formation were evaluated using pseudocontinuous arterial spin labeling (pCASL) and digital subtraction angiography (DSA). Modified Rankin scale (mRS) score and complication rates were compared between the two groups. In addition, correlations between Matsushima grades, early-arriving flow proportion (EFP), and lesion-side cerebrovascular (LCBV) scores were analyzed. The surgical group showed significantly lower mRS scores than the medical group (=0.018), with no significant differences in complication rates at the 6-month follow-up (=0.861). CBF differed significantly among affected MCA segments ( < 0.001), particularly in the insular and opercular regions (M2-M3) (=0.006). Matsushima grades in unilateral CTI/MCAO patients were negatively correlated with preoperative LCBV scores ( = -0.468, =0.005) and EFP ( = -0.648, =0.007). EFP demonstrated high accuracy in predicting LCBV scores in CTI/MCAO patients (AUC = 0.902, =0.004). STA-MCA bypass surgery improved neurological outcomes in CTI/MCAO patients, particularly those with poor preoperative collateral compensation. EFP may serve as a reliable, noninvasive tool for assessing collateral circulation status in this population.
缺血性中风是全球导致死亡和残疾的主要急症之一，其特点是急性起病，迫切需要及时的医疗干预以降低死亡率和长期残疾率。慢性终末期颈内动脉和/或大脑中动脉闭塞（CTI/MCAO）是颅内动脉闭塞性疾病的一种重要亚型。颞浅动脉-大脑中动脉（STA-MCA）搭桥术已被提出用于改善脑血流量（CBF）和脑血管储备（CVR），可能改善神经功能结局。然而，其在CTI/MCAO患者中的安全性和有效性仍存在争议。2019年7月至2022年6月期间，南京脑科医院共纳入107例CTI/MCAO患者，分为手术治疗组和药物治疗组。使用伪连续动脉自旋标记（pCASL）和数字减影血管造影（DSA）评估脑灌注和侧支循环形成。比较两组的改良Rankin量表（mRS）评分和并发症发生率。此外，分析了松岛分级、早期到达血流比例（EFP）和病变侧脑血管（LCBV）评分之间的相关性。手术组的mRS评分显著低于药物治疗组（=0.018），6个月随访时并发症发生率无显著差异（=0.861）。受影响的大脑中动脉节段的CBF差异显著（<0.001），特别是在岛叶和岛盖区域（M2-M3）（=0.006）。单侧CTI/MCAO患者的松岛分级与术前LCBV评分（=-0.468，=0.005）和EFP（=-0.648，=0.007）呈负相关。EFP在预测CTI/MCAO患者的LCBV评分方面具有较高的准确性（AUC=0.902，=0.004）。STA-MCA搭桥手术改善了CTI/MCAO患者的神经功能结局，尤其是术前侧支循环代偿较差的患者。EFP可能是评估该人群侧支循环状态的可靠无创工具。
