The clinical effect analysis of internal maxillary artery⁃radial artery⁃cerebral artery bypass for the treatment of cerebral vascular disease

Abstract

Objective To investigate the clinical effect of cerebral vascular disease treated by transplantations of the short⁃segment radial artery (RA) using the internal maxillary artery (IMA) as the feeding artery. Methods and Results The clinical data of 5 cases with cerebral vascular disease treated by IMA⁃RA⁃cerebral artery bypass (IMAB) from August 2018 to April 2021 in the First Hospital of China Medical University were retrospectively analyzed. There were 3 cases of dissecting aneurysms [one case of right middle cerebral artery (MCA) M2 segment, one case of left MCA M1 segment, one case of right posterior cerebral artery (PCA) P2 segment], and 2 cases of vertebral basilar artery ischemia [one case of bilateral vertebral artery (VA) occlusion, one case of severe basilar artery (BA) stenosis]. Two patients underwent the IMA⁃RA⁃M2 bypass, and 3 patients underwent the IMA⁃RA⁃P2 bypass. Intraoperative indocyanine green angiography (ICGA) and Doppler ultrasonography confirmed patency of the RA in 4 cases and occluded RA in one case (the anastomosis of IMA⁃RA was opened, the intima of IMA was dissociated from the media, and RA was unobstructed after resuture). One patient developed basal ganglia infarction after the surgery. The RA blood flow was measured by ultrasound 123, 51, 77, 69 ml/min in 4 patients at one week after the surgery. One patient had a RA blood flow of 89 ml/min on 6 months after the surgery (69 ml/min on one week after the surgery), and one patient had a RA blood flow of 66 ml/min 26 months after the surgery (51 ml/min on one week after the surgery). One patient with dissociated M1 segment aneurysm with ischemic onset developed ischemic infarction in basal ganglia region after open aneurysm and bypass, and modified Rankin Scale (mRS) increased by one point on one week after surgery. mRS score of 3 patients decreased by one point and one patient had no change; after 8-40 months of follow⁃up, all patients recovered well, with mRS score of 0 in 2 cases, one in 2 cases, and 2 in one case. Conclusions The IMAB can provide moderate flow of blood supply to brain tissue, and the RA has good patency and stable flow during long⁃term follow⁃up. This operation can be used to treat patients with cerebral vascular disease of choosy and reduce the risk of cerebral ischemia effectively.