{"title":"STA-MCA搭桥手术对慢性颈内动脉终末和/或大脑中动脉闭塞伴侧支循环受损患者的益处增强:介绍一种新的侧支补偿评估方法。","authors":"Cheng Qiu, Yanping Zhang, Zhiqiang Yu, Yonghui Xu, Yongjiang Huang, Tianci Huang, Jun Ma, Jinbing Zhao","doi":"10.1155/emmi/5059097","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> The surgical group showed significantly lower mRS scores than the medical group (<i>p</i>=0.018), with no significant differences in complication rates at the 6-month follow-up (<i>p</i>=0.861). CBF differed significantly among affected MCA segments (<i>p</i> < 0.001), particularly in the insular and opercular regions (M2-M3) (<i>p</i>=0.006). Matsushima grades in unilateral CTI/MCAO patients were negatively correlated with preoperative LCBV scores (<i>γ</i> <sub>s</sub> = -0.468, <i>p</i>=0.005) and EFP (<i>γ</i> <sub>s</sub> = -0.648, <i>p</i>=0.007). EFP demonstrated high accuracy in predicting LCBV scores in CTI/MCAO patients (AUC = 0.902, <i>p</i>=0.004). <b>Conclusion:</b> 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.</p>","PeriodicalId":11528,"journal":{"name":"Emergency Medicine International","volume":"2025 ","pages":"5059097"},"PeriodicalIF":1.2000,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756939/pdf/","citationCount":"0","resultStr":"{\"title\":\"Enhanced Benefit of STA-MCA Bypass Surgery in Chronic Terminal Internal Carotid and/or Middle Cerebral Artery Occlusion Patients With Impaired Collateral Circulation: Introducing a Novel Assessment Approach for Collateral Compensation.\",\"authors\":\"Cheng Qiu, Yanping Zhang, Zhiqiang Yu, Yonghui Xu, Yongjiang Huang, Tianci Huang, Jun Ma, Jinbing Zhao\",\"doi\":\"10.1155/emmi/5059097\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> The surgical group showed significantly lower mRS scores than the medical group (<i>p</i>=0.018), with no significant differences in complication rates at the 6-month follow-up (<i>p</i>=0.861). CBF differed significantly among affected MCA segments (<i>p</i> < 0.001), particularly in the insular and opercular regions (M2-M3) (<i>p</i>=0.006). Matsushima grades in unilateral CTI/MCAO patients were negatively correlated with preoperative LCBV scores (<i>γ</i> <sub>s</sub> = -0.468, <i>p</i>=0.005) and EFP (<i>γ</i> <sub>s</sub> = -0.648, <i>p</i>=0.007). EFP demonstrated high accuracy in predicting LCBV scores in CTI/MCAO patients (AUC = 0.902, <i>p</i>=0.004). <b>Conclusion:</b> 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.</p>\",\"PeriodicalId\":11528,\"journal\":{\"name\":\"Emergency Medicine International\",\"volume\":\"2025 \",\"pages\":\"5059097\"},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2025-01-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756939/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Emergency Medicine International\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1155/emmi/5059097\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Emergency Medicine International","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1155/emmi/5059097","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景:缺血性脑卒中是世界范围内导致死亡和残疾的主要紧急疾病之一,其特点是发病急性,迫切需要及时的医疗干预,以降低死亡率和长期残疾。慢性颈内动脉终末和/或大脑中动脉闭塞(CTI/MCAO)是颅内动脉闭塞性疾病的一个重要亚型。颞浅动脉到mca (STA-MCA)旁路被认为可以改善脑血流量(CBF)和脑血管储备(CVR),潜在地改善神经学预后。然而,其在CTI/MCAO患者中的安全性和有效性仍存在争议。方法:选取2019年7月至2022年6月南京市脑科医院收治的CTI/MCAO患者107例,分为手术组和内科组。采用假连续动脉自旋标记(pCASL)和数字减影血管造影(DSA)评估脑灌注和侧支形成。比较两组患者改良Rankin评分(mRS)及并发症发生率。此外,我们还分析了松岛分级、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。结果:手术组mRS评分明显低于内科组(p=0.018), 6个月随访时并发症发生率差异无统计学意义(p=0.861)。受影响的MCA节段之间的CBF差异显著(p < 0.001),特别是在岛和眼区(M2-M3) (p=0.006)。单侧CTI/MCAO患者的Matsushima分级与术前LCBV评分(γ s = -0.468, p=0.005)和EFP (γ s = -0.648, p=0.007)呈负相关。EFP预测CTI/MCAO患者LCBV评分具有较高的准确性(AUC = 0.902, p=0.004)。结论:STA-MCA搭桥手术改善了CTI/MCAO患者的神经预后,特别是术前侧支代偿差的患者。EFP可作为评估该人群侧支循环状况的可靠、无创工具。
Enhanced Benefit of STA-MCA Bypass Surgery in Chronic Terminal Internal Carotid and/or Middle Cerebral Artery Occlusion Patients With Impaired Collateral Circulation: Introducing a Novel Assessment Approach for Collateral Compensation.
Background: 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. Methods: 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. Results: The surgical group showed significantly lower mRS scores than the medical group (p=0.018), with no significant differences in complication rates at the 6-month follow-up (p=0.861). CBF differed significantly among affected MCA segments (p < 0.001), particularly in the insular and opercular regions (M2-M3) (p=0.006). Matsushima grades in unilateral CTI/MCAO patients were negatively correlated with preoperative LCBV scores (γs = -0.468, p=0.005) and EFP (γs = -0.648, p=0.007). EFP demonstrated high accuracy in predicting LCBV scores in CTI/MCAO patients (AUC = 0.902, p=0.004). Conclusion: 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.
期刊介绍:
Emergency Medicine International is a peer-reviewed, Open Access journal that provides a forum for doctors, nurses, paramedics and ambulance staff. The journal publishes original research articles, review articles, and clinical studies related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care, sports medicine, wound care, and toxicology.