Comparison Of Therapeutic Efficacy Between Encephaloduroarteriosynangiosis And Medical Treatment In Patients With Atherosclerotic Middle Cerebral Artery Occlusion

BackgroundEncephaloduroarteriosynangiosis(EDAS)as a form of indirect revascularization has been recently proposed as a potentially promising new treatment for patients of intracranial atherosclerotic disease(ICAD)with ongoing cerebral ischemic events despite medical therapy.But the evidence was somewhat limited by small number of enrolled patients,retrospective design or lack of controls.Herein,we conducted this ambispective cohort study to compare the prognostic roles between medical therapy and ED AS in patients with atherosclerotic MCAO.MethodsWe consecutively enrolled patients who were hospitalized in department of neurology or neurosurgery in the PL A general Hospital from January 2014 to June 2017 and were diagnosed as atherosclerotic middle cerebral artery occlusion by digital subtraction angiography.Hospitalized adverse events,follow-up adverse events,functional status and memory capacity were compared between ED AS(n=60)and medical group(n=65)to evaluate the efficacy of EDAS and medical management for atherosclerotic MCAO.ResultsDuring 23.7 months of mean follow-up,rates of follow-up adverse events,including ischemic events in the territory of the qualifying MCA,and death from vascular causes,were not statistically significant in patients treated with EDAS or medical therapy(6.7%vs.12.3%;p=0.285).Landmark analyses revealed that at 6-month follow-up,there was no significant difference for follow-up adverse event rates,while the opposite finding was demonstrated for the subsequent period(EDAS 1/57[1.7%]vs.medical management 7/64[10.9%];p=0.024).And the P value for the interaction between time(first 6 months vs.subsequent period)and treatment with respect to adverse events was 0.045.In addition,no significant differences were found with the respect to neural function status or cognitive ability.ConclusionsEDAS can be considered effective and safe for patients with atherosclerotic MCAO,especially in the long-term.Additional randomized,multicenter trials with longer follow-up are required.