Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2025
Indirect revascularization after bypass surgery for intracranial atherosclerotic steno-occlusive disease.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Chung Yuwhan, Lee Sung Ho, Kim Kangmin, Kang Hyun-Seung, Kim Jeong Eun, Cho Won-Sang
Аннотация
OBJECTIVES: Indirect revascularization after bypass surgery for intracranial atherosclerotic steno-occlusive disease (ICAD) remains controversial. We aimed to evaluate indirect revascularization after direct bypass surgery in patients with ICAD.
METHODS: Among 245 patients with ICAD who underwent direct bypass surgery between 2003 and 2022, 191 patients were ultimately enrolled in this study. Treatment outcomes were compared between combined bypass (n = 162 [84.8 %]) and direct bypass alone (n = 29) groups. Multivariable analyses were performed to identify significant predictors of indirect revascularization and favorable clinical outcomes.
RESULTS: There were no significant differences in overall baseline characteristics or treatment outcomes between the two groups. At the last angiographic follow-up at 27.1 ± 27.1 months (range, 5.0-97.3 months), the rate of indirect revascularization was significantly higher in the combined bypass group than in the direct bypass alone group (39.5 % versus 17.2 %, P = .022). Significant predictors of indirect revascularization included combined bypass (OR 3.175, 95 % CI 1.142-8.826; P = .027) rather than direct bypass alone, and significant stenosis and occlusion in the middle cerebral artery rather than the internal carotid artery (OR 1.961, 95 % CI 1.022-3.763; P = .043). An additional analysis revealed that a good preoperative clinical status (OR 0.141, 95 % CI 0.066-0.302, P < .001) and indirect revascularization (OR 5.508, 95 % CI 1.003-30.245, P = .050) were independent predictors of favorable clinical outcomes.
CONCLUSION: Indirect revascularization was more pronounced after combined bypass than direct bypass alone and was a significant predictor of favorable clinical outcomes.
METHODS: Among 245 patients with ICAD who underwent direct bypass surgery between 2003 and 2022, 191 patients were ultimately enrolled in this study. Treatment outcomes were compared between combined bypass (n = 162 [84.8 %]) and direct bypass alone (n = 29) groups. Multivariable analyses were performed to identify significant predictors of indirect revascularization and favorable clinical outcomes.
RESULTS: There were no significant differences in overall baseline characteristics or treatment outcomes between the two groups. At the last angiographic follow-up at 27.1 ± 27.1 months (range, 5.0-97.3 months), the rate of indirect revascularization was significantly higher in the combined bypass group than in the direct bypass alone group (39.5 % versus 17.2 %, P = .022). Significant predictors of indirect revascularization included combined bypass (OR 3.175, 95 % CI 1.142-8.826; P = .027) rather than direct bypass alone, and significant stenosis and occlusion in the middle cerebral artery rather than the internal carotid artery (OR 1.961, 95 % CI 1.022-3.763; P = .043). An additional analysis revealed that a good preoperative clinical status (OR 0.141, 95 % CI 0.066-0.302, P < .001) and indirect revascularization (OR 5.508, 95 % CI 1.003-30.245, P = .050) were independent predictors of favorable clinical outcomes.
CONCLUSION: Indirect revascularization was more pronounced after combined bypass than direct bypass alone and was a significant predictor of favorable clinical outcomes.