The efficacy of STA-MCA double anastomosis comparing to single anastomosis in chronic internal carotid artery occlusion patients

Xuying Chang; Xiaoling Ruan; Jiangbo Ding; Peiyu Ma; Guangwu Yang; Ruoyu Zhang; Yuhan Li; Kunpeng Na; Hang Xu; Linjie Mu; Xingkui Zhang; Zhiwei Tang

doi:10.1016/j.clineuro.2023.107947

The efficacy of STA-MCA double anastomosis comparing to single anastomosis in chronic internal carotid artery occlusion patients

Clin Neurol Neurosurg. 2023 Oct:233:107947. doi: 10.1016/j.clineuro.2023.107947. Epub 2023 Aug 19.

Authors

Xuying Chang¹, Xiaoling Ruan², Jiangbo Ding³, Peiyu Ma⁴, Guangwu Yang¹, Ruoyu Zhang¹, Yuhan Li¹, Kunpeng Na¹, Hang Xu⁵, Linjie Mu⁶, Xingkui Zhang⁶, Zhiwei Tang⁷

Affiliations

¹ Kunming Medical University, Kunming, Yunnan, China.
² University of Pavia, Pavia, Italy.
³ Department of Neurosurgery, South Yunnan Central Hospital of Yunnan Province (The First People,s Hospital of Honghe Prefecture), Mengzi, Yunnan,China.
⁴ Department of surgery, The Second People's Hospita of Honghe Prefecture, Jianshui, Yunnan, China.
⁵ Department of Pain,The First People's Hospital of Zhaotong, Zhaotong, Yunnan, China.
⁶ Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
⁷ Department of Neurosurgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China. Electronic address: tangzhiwei7755@hotmail.com.

PMID: 37611351
DOI: 10.1016/j.clineuro.2023.107947

Abstract

Objective: To investigate the efficacy of STA-MCA double-anastomosis and single-anastomosis in patients with cerebral hypoperfusion caused by chronic internal carotid artery occlusion(CICAO).

Methods: In this retrospective study, data were collected from 19 patients with CICAO who underwent STA-MCA anastomosis at our hospital between January 2016 and January 2022, and they were divided into single anastomosis group and double anastomosis group according to the surgical method. The study collected general clinical data from both groups, including age, sex, lipid levels, blood pressure, glucose levels, smoking and alcohol consumption. Additionally, pre- and postoperative neurological function, cerebral hemodynamic parameters, and postoperative ischemic events were also recorded. By combining our study findings with the existing literature, a comparative analysis of the efficacy of single- and double-anastomosis in patients with CICAO was conducted.

Results: Prior to surgical treatment，there were no statistically significant differences in cerebral hemodynamic parameters, including rob (0.65 ± 0.09 VS. 0.62 ± 0.04), rut (1.73 ± 0.40 VS. 1.99 ± 0.53), and rTMax (2.02 ± 0.49 VS. 1.72 ± 0.46), as well as neurofunctional scores, including modified Rankin Scale (MRS) (2.8 ± 1.03 VS. 2.4 ± 0.88) and National Institutes of Health Stroke Scale (NIHSS) (9.1 ± 5.08 VS. 8.3 ± 4.09) between the two groups. After operation, rCBF (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 rMTT (1.99 ± 0.53 VS.1.27 ± 0.42, p = 0.0447) and rTMax (1.72 ± 0.46 VS.1.16 ± 0.16, p = 0.038) showed significant differences postoperatively 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. In summary, the double-anastomosis group showed better improvement in rCBF and NIHSS scores compared to the single-anastomosis group.(ΔrCBF: 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 20.3 ± 18.6 months, and there were no ischemic events in either group during the follow-up period.

Conclusion: STA-MCA revascularization can improve CBF in patients with hypoperfusion caused by CICAO, and prevent the reoccurrence of ischemic stroke effectively. Compared with single-anastomosis, double-anastomosis can provide more CBF and improve neurologic dysfunction.

Keywords: CTP; Chronic internal carotid artery occlusion; Neurological function score; STA-MCA double anastomosis; STA-MCA single anastomosis.