Duan Yu, Li Jian, Zhang Xin, Li Shihong, Chai Qiliang, Zhang Yingying, Huang Guohui, Xu Ziwei, Li Zhuyu, Mao Renling, Dai Dongwei
Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China.
Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
Front Aging Neurosci. 2025 Mar 5;17:1548319. doi: 10.3389/fnagi.2025.1548319. eCollection 2025.
The safety and clinical effectiveness of extracranial-intracranial (EC-IC) bypass surgery in elderly patients with atherosclerotic internal carotid artery and/or middle cerebral artery steno-occlusive (ACMSO) disease remain ambiguous. Here, we analyzed our experience of EC-IC bypass surgery to evaluate its clinical safety and effect on the cognitive function for elderly patients with ACMSO.
This retrospective study enrolled patients >60 years of age diagnosed with ACMSO who underwent EC-IC bypass surgery at the authors' center between January 2018 and January 2021. Indications for bypass surgery included symptomatic ACMSO defined by cerebral angiography and evidence of relative hypoperfusion in the territories of steno-occlusive arteries based on computed tomography perfusion (CTP) neuroimaging. All patients underwent the Montreal Cognitive Assessment preoperatively and 2 years after bypass surgery. Clinical data, such as the National Institute of Health Stroke Scale and cognitive function scores, and CTP parameters were retrospectively analyzed.
The study cohort ultimately included data from 65 patients (60-68 years of age; median age, 66 years) who underwent 82 bypass surgeries. The patency rate of bridge arteries was 100% on intraoperative fluoroscopy and 95.0% (76/80) according to cerebral angiography at the last follow-up. The perioperative stroke rate was 1.54 % and the mortality rate was 3.08% in the 2nd year of follow-up. Compared with preoperative data, the mismatch volume of CTP was reduced ( < 0.001), and the Montreal Cognitive Assessment score significantly increased ( < 0.001) 2 years after bypass surgery. Forty patients in the cognitive improvement group had a higher educational level ( = 0.020), shorter course of disease ( = 0.041), shorter mean transit time (MTT) ( < 0.001), and shorter time to peak value ( = 0.015) on CTP, as determined by single-factor analysis before bypass, compared with those in the inactive group. Based on multivariate logistic regression analysis, a shorter preoperative MTT was an independent clinical factor for cognitive improvement after bypass (odds ratio 0.452 [95% confidence interval 0.082-0.760]; = 0.003).
EC-IC bypass surgery was safe and improved cognitive function in elderly patients diagnosed with ACMSO. Reversible cerebral perfusion function is one of the better prognoses, which needs to be confirmed in future study.
颅外-颅内（EC-IC）旁路手术在患有动脉粥样硬化性颈内动脉和/或大脑中动脉狭窄闭塞（ACMSO）疾病的老年患者中的安全性和临床有效性仍不明确。在此，我们分析了我们进行EC-IC旁路手术的经验，以评估其对患有ACMSO的老年患者的临床安全性和对认知功能的影响。
这项回顾性研究纳入了2018年1月至2021年1月期间在作者所在中心接受EC-IC旁路手术、年龄>60岁且被诊断为ACMSO的患者。旁路手术的指征包括脑血管造影定义的症状性ACMSO以及基于计算机断层扫描灌注（CTP）神经影像学显示的狭窄闭塞动脉供血区域相对灌注不足的证据。所有患者在术前及旁路手术后2年均接受蒙特利尔认知评估。对临床数据，如美国国立卫生研究院卒中量表和认知功能评分以及CTP参数进行回顾性分析。
该研究队列最终纳入了65例患者（年龄60 - 68岁；中位年龄66岁）的数据，这些患者接受了82次旁路手术。术中透视显示桥血管通畅率为100%，末次随访时脑血管造影显示通畅率为95.0%（76/80）。围手术期卒中发生率为1.54%，随访第2年死亡率为3.08%。与术前数据相比，旁路手术后2年CTP的不匹配体积减少（<0.001），蒙特利尔认知评估评分显著增加（<0.001）。旁路手术前单因素分析显示，认知改善组的40例患者与无改善组相比，受教育程度更高（=0.020）、病程更短（=0.041）、CTP上的平均通过时间（MTT）更短（<0.001）且达峰时间更短（=0.015）。基于多因素逻辑回归分析，术前较短的MTT是旁路手术后认知改善的独立临床因素（优势比0.452 [95%置信区间0.082 - 0.760]；=0.003）。
EC-IC旁路手术对于诊断为ACMSO的老年患者是安全的且可改善认知功能。可逆性脑灌注功能是较好的预后因素之一，这需要在未来研究中进一步证实。
