| Objective:Stenosis or occlusion of the aortic arch and its branches is common in Takayasu arteritis,leading to severe cerebral blood supply insufficiency.It has been reported that sole-and multi-supra-aortic artery bypass are both effective methods to improve the cerebral blood flow,alleviate the symptoms of cerebral ischemia and prevent stroke.However,there is no study to compare these two methods.The purpose of this study is to compare the efficacy and safety of sole-and multi-supra-aortic artery bypass in the treatment of Takayasu arteritis patients with severe cerebral ischemia and to provide a reference for selection of appropriate surgical methods.Methods:This study used a single-center,retrospective cohort study of patients with a diagnosis of Takayasu arteritis and a surgery of supra-aortic artery bypass grafting in Peking Union Medical College Hospital.The patients were divided into two groups according to the surgical methods:sole-supra-aortic artery bypass(SSAAB)group and multi-supra-aortic artery bypass(MSAAB)group.The study was divided into two parts.The first part compared the perioperative outcomes of the two groups,including the incidence of cerebrovascular event,cerebral hyperperfusion syndrome(CHS)and other perioperative complications.The second part is to compare the long-term outcomes of the the two groups,including the long-term cerebrovascular event-free survival probability and complication-free survival probability.Results:A total of 52 patients(27 in the SSAAB group and 25 in the MSAAB group)were included in the first part.The primary outcomes occurred in 8 patients(15%)during perioperative period,including 3 ischemic stroke and 5 cerebral hemorrhage(1 of whom died).There was no significant difference in the incidence of primary outcomes 30 days after surgery between these two groups(11%vs 20%;RR=0.56,95%CI:0.15-2.09;P>0.05).The overall incidence of CHS was 15%.The SSAAB group had a significantly lower incidence of CHS(4%vs 28%;RR=0.13,95%CI:0.02～1.00,P=0.022)and lower incidence of postoperative complications(22%vs 64%;RR=0.35,95%CI:0.16～0.75;P=0.002)than the MSAAB group.In addition,the previous reconstruction of supra-aortic artery was an independent risk factor of postoperative cerebral hemorrhage(P=0.037,OR=9.78,95%CI:1.15～82.9).Lack of preoperative corticosteroids therapy was independently related to the increased incidence of postoperative ischemic stroke(P=0.012,OR=30.67,95%CI:2.13～442.60).A total of 43 patients(20 in the SSAAB group and 23 in the MSAAB group)were included in the second part.The median follow-up period was 43 months.The 1-year cerebrovascular event-free survival rate of SSAAB group and MSAAB group was 80%and 78%respectively.No cerebrovascular event occurred in 1-5 years of follow-up.The 1-,3-,and 5-year complication-free survival rate were 80%,74%and 74%in the SSAAB group and 74%,74%,and 69%in the MSAAB group.Kaplan-Meier curve showed no significant difference between the two groups in long-term cerebrovascular event-free survival rate(P=0.550)and complication-free survival rate(P=0.311).The previous reconstruction of supra-aortic artery is an independent risk factor for long-term cerebrovascular event-free survival(HR=4.73,95%CI:1.13-19.81,P=0.033)and complication-free survival(HR=4.58,95%CI:1.13-18.59,P=0.033).Conclusion:For Takayasu arteritis patients with severe cerebral ischemia and multiple branches of aortic arch involved,the SSAAB has lower risks of early postoperative CHS and complications than the MSAAB,and these two methods share a similar long-term outcome. |
