Clinical Study Of STA-MCA Anastomosis In Ischemic Cerebrovascular Disease

[Objective] Superficial temporal artery to middle cerebralartery anastomosis can supply blood from extracranial system intointracranial system. In 1967, successful STA-MCA anastomosis wasreported by Dr. MG Yashargil and Donaghy in Switzerland and Boston.STA-MCA anastomosis expand rapidly all over the world to treatedwith ischemic cerebrovascular disease. The effect of anastomosis hasbeen denied by EC/IC Study Group in 1985, a lot of specialists losethe interest in this bypass. But EC/IC Study Group does not analyzethe hemodynamic insufficiency. Due to the development ofhemodynamics study, we knew better in pathology of ischemiccerebrovascular disease and the effect of STA-MCA anastomosis. Thisarticle reviews the usefulness of STA-MCA Anastomosis on patientswith ischemic cerebrovascular disease by hemodynamics changes andclinical scales.[Materials and Methods] 5 cases of ischemic cerebrovasculardiseases accord with follow conditions: (1) frequently occurredtransient ischemia attach(TIA) or non-deformity stroke, impotenceafter medical treatment; (2) carotid artery, middle cerebral arterystenosis or occlusion, not suit for CEA or stent assistedangioplasty (3) hemodynamic insufficiency in artery stenosis region,absent of enough sidecirculation (4)less than 70 years old, nogeneral anaesthesia contra(cardiac inadequacy, renal inadequacy,hapetic inadequacy, et al); (5) no serious nervous system functionalimpairment caused by large area infarction. All patients were treated with antiplatelet or anticoagulation,fluid expansion, fluid replacement agents in acute stage and treatedwith antihyperglycaemia agents, antihyperlipemia agents andAntihyperglycaemia agents if necessary. 4～6 weeks after stroke,Patients were performed STA-MCA anastomosis under generalanaesthesia and was treated with antibiotic, arsprin(150mg/day) andantihyperglycaemia agents, antihyperlipemia agents andantihyperglycaemia agents if necessary to avoid recrunce. CTperfusion scan and CTA were performed after the operation in orderto know the regional cerebral blood flow and open status ofanastomose.Follow-up was given to those patients once every 6 months andfollow-up period lasted 6 to 24 months, average 20 months. Medicalrecords collected included: (1) Recurrence and morbidity during theperiod of follow-ups; (2) Cerebral stroke clinic nervous functiondefect level scale, from 0 to 45, lower score means nervous functionto be improved; (3) Fluid of STA inspection by TCD in order to knewthe open status of anastomose.[Results]1. Operative complications: No patient has nervous systemimpairment happened after STA-MCA anastomosis. All patients have notsuffered TIA or stroke in perioperation stage. All patients'swounds have good healing.2. Regional cerebral blood flow after STA-MCA anastomosis:Significant differences were shown between pre-operation and post-operation in regional cerebral blood flow approved by CT perfusionscan. Regional cerebral blood flow resume normal. 3. Recurrence and morbidity during the period of follow-ups: Allpatients have not suffered TIA or stroke after STA-MCA anastomosisgroup. No patient died.4. Cerebral stroke clinic nervous function defect level scale:Patients' cerebral stroke clinic nervous function defect levelscale has been improved after operation, indicating nervous functiondefect to be improved.[Conclusion]1. Regional cerebral blood flow can be improved by STA-MCAanastomosis in order to improve nervous function defect, avoidstroke recurrence and improve prognosis.2. Perfusion CT can confirm the regional cerebral blood flowof the patients and the usefulness of STA-MCA anastomosis.3. No operative complication was happened in STA-MCAanastomosis.