The Efficacy Of STA-MCA Double Anastomosis Comparing To Single Anastomosis In Chronic Internal Carotid Artery Occlusion Patients

Objective: By collecting neurological function scores,perfusion data and clinical data in patients with chronic internal carotid artery occlusion to investigate the efficacy of STA-MCA double-anastomosis and STA-MCA single-anastomosis in patients with cerebral hypoperfusion caused by chronic internal carotid artery occlusion(CICAOP).Methods: The data of 19 patients with CICAO treated by STA-MCA anastomosis in our hospital from January 2016 to January 2023 were collected,and they were divided into single anastomosis group and double anastomosis group according to the surgical method.The general clinical data,pre-and postoperative neurological function and cerebral hemodynamic parameters,and postoperative ischemic events of the two groups were collected.Combined with the literature,the efficacy of single and double anastomosis in CICAO patients was compared.Results: There was no statistical difference in general clinical data including age,sex,lipids,blood pressure,glucose,smoking and alcohol consumption.There was also no significant difference in the cerebral hemodynamic parameters including r CBF(0.65±0.09 VS.0.62±0.04),r MTT(1.73±0.40 VS.1.99±0.53)and r TMax(2.02±0.49 VS.1.72±0.46)and the neurofunctional scores including MRS(2.8±1.03 vs.2.4±0.88)and NIHSS(9.1±5.08 vs.8.3±4.09)between the two groups before surgical treatment.After operation,r CBF(single: 0.65±0.09 VS.0.84±0.08,p=0.007;double: 0.62±0.04 VS.1.08±0.20,p= 0.001)were significantly increased in both groups,but the r MTT(1.99±0.53 VS.1.27±0.42,p=0.0447)and r TMax(1.72±0.46 VS.1.16±0.16,p=0.038)were significant different only in the double anastomosis group.The MRS(single:1.8±1.23,double: 1.7±0.9)in both groups and the NIHSS(7.2±5.11)in single anastomosis group were not improved after surgery,while the NIHSS(8.3±4.09 VS.4.4±3.08,p=0.037)in double anastomosis group was improve significantly.When compared the parameters between the two groups after surgery,the r CBF and NIHSS improvement in the double anastomosis group were better than those in the single anastomosis group(Δr CBF: 0.19±0.09 VS.0.45±0.18,p=0.02,ΔNIHSS: 1.9±0.56 VS.4±1.73,p=0.002).The cases were followed up for 22.3 ± 18.6 months,and there were no ischemic events in either group during the follow-up period.Conclusion: STA-MCA revascularization can improve cerebral blood flow in patients with hypoperfusion caused by CICAO,and prevent the reoccurrence of ischemic stroke effectively.Compared with single anastomosis,double anastomosis can provide more cerebral blood flow and improve neurologic dysfunction.