STA-proximalMCA吻合術を施行した慢性閉塞性内頸動脈系病変のlong term outcome

Abstract

To evaluate the efficacy of superficial temporal artery (STA)-proximal middle cerebral artery (MCA) anastomosis, we analyzed the long term outcome of patients treated with bypass surgery.Over a 12-year period, 87 patients were defined by clinical and laboratory criteria as suffering from hemodynamic cerebral ischemia. All patients had one or more episodes of focal cerebral ischemia due to unilateral internal carotid or middle cerebral artery occlusion. Computerized tomography scans either were normal or showed evidence of watershed infarction. The cerebral blood flow and/or cerebrovascular reserve capacity or cerebral oxygen extraction fraction were found to be impaired in all patients. Based on these criteria, STA-proximal MCA anastomosis was performed. No patients suffered postoperative strokes, resulting in a morbidity rate of 0%. Over a mean follow-up period of 50 months, 3 patients dropped out and the follow-up rate was 96.5%. Only 1 patient died of stroke (brain stem infarction) and other causes of death were myocardial infarction, malignant neoplasm, renal failure, diabetic coma and pneumonia. No significant difference was demonstrated in survival rate between 84 patients and the age- and sex-matched control. Eight patients had another episode of cerebral ischemia. The 2-, 5- and 10-year cumulative recurrence rates were 4.8%, 8.5% and 16.4%, respectively. Only 2 patients had further ischemic events ipsilateral to the side of bypass surgery, and their symptoms were transient ischemic attacks.In view of these findings, we conclude that STA-proximal MCA anastomosis constitutes appropriate therapy for patients with hemodynamic cerebral ischemia.