Risk Factors For Worsening Neurological Deficit After STA-MCA Bypass Surgery For Atherosclerotic Ischemic Cerebrovascular Disease

Objective: To explore the risk factors of neurological deficit aggravation in patients with atherosclerotic ischemic cerebrovascular disease after superficial temporal artery-middle cerebral artery(STA-MCA)bypass surgery,so as to determine the appropriate treatment for this kind of disease.Method:1.Data sources and criteria for enrollment: STA-MCA bypass surgery was performed in patients with atherosclerotic ischemic cerebrovascular disease from August 2016 to October 2018 in the East Hospital of the Second Hospital of Hebei Medical University.The criteria for admission were:(1)repeated transient ischemic attack(TIA)or imaging confirmed definite infarction with or without neurological impairment;(2)DSA confirmed the presence of vascular lesions consistent with clinical symptoms,and the ipsilateral superficial temporal artery was suitable for bypass surgery.These lesions included extracranial or/or intracranial internal carotid artery occlusion or stenosis,middle cerebral artery occlusion or stenosis.Occlusion or stenosis of the main vein.(3)CTP examination confirmed the presence of hypoperfusion in the affected side,and the relative average ratio of the affected side to the healthy side was more than 1.63 through the real time(MTT).STA-MCA bypass was performed for those who met the above three conditions.Exclusion criteria:(1)over 70 years old;(2)severe cardiopulmonary disease,renal insufficiency,poor tolerance to surgery;(3)the presence of massive cerebral infarction or in the acute phase of cerebral infarction(less than one month);(4)patients who can not be examined by DSA and CTP for various reasons;(5)patients with moyamoya disease.A total of 35 cases were included in this study.2.The severity of neurological deficit after STA-MCA was judged as follows: neurological deficit was aggravated within 15 days after STA-MCA bypass: a.Postoperative hyperperfusion manifestations(patients manifested as excitement,multilingualism,irritability,intractable headache,etc.);B.Postoperative ipsilateral or contralateral new infarction or hemorrhage;C.Reversible neurological changes: dysarthria,involuntary movement of hands And motor sensory aphasia;D.focal epilepsy and so on.3.Observing factors: In this study,patients’ gender,age,hypertension,smoking,alcohol consumption,basic diseases(diabetes mellitus or hyperlipidemia at least one item),number of vascular lesions(single or multiple branches),preoperative neurological dysfunction,history of cerebral infarction(generally referred to as cerebral infarction occurring one month before operation),operation time(referring to the time from the beginning of operation to the end of operation).)A total of 10 factors were used as observation indicators.4.Comparing content and statistical methods: SPSS21 statistical software was used to process data.Firstly,the high-risk factors of these complications were assessed by single factor(x2 or Fisher’s exact test,etc.);the variables with statistical differences in single factor analysis were further analyzed by multivariate logistic regression analysis;P<0.05 was used as the criterion for differentiating.Results: Through collecting and analyzing the clinical data of 35 patients undergoing STA-MCA bypass surgery,we found that sex(P=0.317),age(P=0.983),hypertension(P=0.727),drinking history(P=0.166),basic diseases(diabetes mellitus or hyperlipidemia at least one item)(P=0.503),number of vascular lesions(single or multiple sides)(P=0.700),history of cerebral infarction(cerebral infarction occurring one month before general finger surgery)(P=0.732).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Smoking history(P=0.016),preoperative neurological dysfunction(P=0.036),and operative time(P=0.000)had significant differences in the incidence of postoperative complications(P<0.05).That is to say,patients with smoking history,patients with preoperative neurological dysfunction,patients with long operation time have an increased incidence of postoperative complications.Multivariate logistic regression analysis showed that smoking(P=0.001)and operation time(P=0.000)were independent risk factors for postoperative complications.Conclusion: Smoking history,preoperative neurological dysfunction and operation time were risk factors for postoperative complications.Multivariate logistic regression analysis showed that smoking and operation time were independent risk factors for postoperative complications.