摘要： 目的 回顾分析以颌内动脉（IMA）为供血动脉、移植短段桡动脉（RA）的中流量搭桥术治疗脑血管病的疗效。方法与结果 5例患者均为2018年8月至2021年4月在中国医科大学附属第一医院行IMA-RA-脑动脉搭桥术（IMAB）的脑血管病病例，其中解离性动脉瘤3例（右大脑中动脉M2段1例、左大脑中动脉M1段1例、右大脑后动脉P2段1例），椎基底动脉系统缺血2例（双侧椎动脉闭塞1例、基底动脉重度狭窄1例）。分别行IMA-RA-M2（2例）和IMA-RA-P2（3例）搭桥术，术中吲哚菁绿荧光血管造影术和多普勒超声显示桡动脉血流通畅4例、闭塞1例（经重新吻合桥血管血流通畅）。术后1周，5例移植桡动脉保持通畅，其中4例测量桡动脉血流量分别为123、51、77和69 ml/min，改良Rankin量表（mRS）评分较术前升高1分1例、降低1分3例、无变化1例；其中1例M1段解离性动脉瘤患者，血管搭桥术并旷置动脉瘤后发生基底节区梗死。术后5~26个月，随访的4例移植桡动脉仍保持通畅，其中2例血流量分别达66和89 ml/min；随访至术后8~40个月，5例神经功能缺损均不同程度改善，mRS评分为零2例、1分2例、2分1例。结论 IMAB手术可为脑组织提供中等流量的血供，长期随访桡动脉通畅性良好、血流量稳定，可有效降低脑缺血风险。

关键词: 脑血管障碍, 脑血管重建术, 颌内动脉(非MeSH词), 桡动脉, 脑血管循环

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.

Key words: Cerebrovascular disorders, Cerebral revascularization, Internal maxillary artery (not in MeSH), Radial artery, Cerebrovascular circulation