Meta-analysis on clinical efficacy of Simiao Yong'an decoction in treatment of peripheral arterial occlusive diseases

Objective:To systematically evaluate the clinical efficacy and safety of Simiao Yong'an Decoction in the treatment of peripheral occlusive disease(PAOD).Methods:Eight randomized controlled clinical trials(RCT)of Simiao Yong'an Decoction in the treatment of PAOD were searched and screened from domestic and foreign databases(all from database construction to March 2020).The quality of the retrieved original studies was evaluated according to the evaluation criteria of Cochrane Handbook 5.1.0,and the included studies were meta-analyzed by RevMan5.3 software.Results:A total of 350 articles were retrieved,among which 14 studies met the inclusion criteria,with a total sample size of 1254 cases.The results of meta-analysis showed that:compared with conventional western Med,combined with Simiao Yong'an Decoction on the basis of western Med treatment can significantly improve the total clinical response rate of patients[RR=1.20,95%CI(1.14,1.27),P<0.00001],improve ankle brachial index(ABI)level[MD=0.79,95%CI(0.66,0.92),P<0.00001]and toe brachial index(TBI)level[RR=0.13,95%CI(0.10,0.16),P<0.00001],decreased c-reactive protein levels[MD=-8.55,95%CI(-8.99,-8.11),P<0.00001]and LDL levels[MD=-0.41,95%CI(-0.62,-0.19),P=0.0002],and increased HDL levels[MD=0.32(0.22,0.43),P<0.00001].There was no statistically significant difference in the incidence of adverse reactions[RR=0.50,95%CI(1.15,1.64),P=0.25].Conclusion:Simiao Yong'an Decoction combined with conventional western Med is more effective than conventional western Med in the treatment of PAOD.However,in view of the limitations of the quality of the analyzed literature,the positive results obtained in this study still need to be further verified by a large sample and multi-center clinical trial with a reliable research program.

INTRACRANIAL ARTERIAL OCCLUSIVE LESION IN PATIENTS WITH GRAVES DISEASE

Objective To investigate the distribution and clinical manifestations of intracranial arterial occlusive lesions （IA- OLs）, and their correlation with thyroid function. Methods We enrolled 7 patients who had Graves＇ disease （GD） with IAOLs screened and evidenced by transcranial Doppler, then further confirmed with digital substract angiography in 2 patients and magnetic resonance angiography in 5 patients. Brain magnetic resonance imaging （MRI） was performed in all 7 patients. Three patients were followed up. Results Among 7 patients, 1 was male and 6 were females. The mean age was 32.0 ± 5.5 （ range from 11 to 49） years old. Six of them had symptoms of GD but one was asymptomatic with abnormality of I3, T4, and thyroid stimulating hormone. The lesions of intracranial arteries were symmetrical bilaterally in the intemal carotid artery system in 6 patients, as well as asymmetrical in 1 patient. Terminal internal carotid artery （TICA） were involved in all 7 patients. Middle cerebral artery （MCA） were involved in 3, anterior cerebral artery in 2, and basilar artery in 1 patient. Net-like collateral vessels and mimic moyamoya disease were observed in the vicinity of the occlusive arteries in 2 patients. All patients presented symptoms of ischemic stroke including transient ischemic attack and/or infarction while IA- OLs were found. Three patients had obvious involuntary movements. Brain MRI revealed infarctions located in the cortex, basal ganglion, or hemiovular center in 5 patients. The remaining 2 patients had normal brain MRI. The neurological symptoms were improved concomitant with relief of the thyroid function in 2 patients, while IAOLs were aggravated with deterioration of the thyroid function in 1 patient. Conclusion IAOLs in patients with GD mainly involve intracranial arteries, especially the TICA and MCA, which is similar to moyamoya disease. The neurological symptoms and severity of involved arteries may relieve while the hyperthyroidism is gradually under control.

Lower Extremity Arterial Occlusive Disease As a Rare Complication of Crohn’s Disease

Objective To investigate the clinical characteristics and treatment strategy of lower extremity arterial occlusive disease in patients with Crohn's disease (CD). Methods Clinical information of 9 cases suffering from lower extremity arterial occlusion and CD was investigated retrospectively. Results All the cases were less than 50 years old and the most were females (8/9). Arterial occlusions occurred in either active (5/9) or inactive (4/9) stage of CD. Besides the arteries of lower extremities, other arteries could also be involved such as aorta, iliac artery, renal artery or mesentery artery. Seven cases had atherosclerotic imaging findings (4 had aortic plaques and 6 had iliac artery stenoses). Embolectomy or thromboendarterectomy were mostly performed. Four (44.4%) cases had recurrent lower limb ischemia. Conclusions Arterial occlusive disease is a rare extraintestinal manifestation of CD. A thorough inspection of aorta is necessary. Embolectomy is mostly preferred. Anticoagulation treatment is highly recommended after the operation.

Transplantation of mobilized peripheral blood mononuclear cells for peripheral arterial occlusive disease of the lower extremity

Objectives To assess the clinical efficacy,safety,and feasibility of autologous transplantation of mobilized peripheral blood mononuclear cells(PBMNCs)for patients with peripheral arterial occlusive disease(PAOD)of the lower extremity.Methods A total of 152 patients with PAOD of the lower extremity were enrolled into this non-controlled observational study from November 2003 to March 2006.All patients received subcutaneous injections of recombinant human granulocyte colony-stimulating factor(G-CSF,450-600μg/day)for 5 days in order to mobilize stem/progenitor cells;their PBMNCs were collected and transplanted by multiple intramuscular injections into ischemic limbs.Patients were followed up for at least 12 weeks.Results At 12 weeks,primary manifestations,including lower limb pain and coldness,were significantly improved in 137(90.1%)of the patients;limb ulcers improved or healed in 46(86.8%)of the 53 patients,while 25 of the 48(47.9%)patients with limb gangrene remained steady or improved.Ankle-brachial index(ABI)improved in 33(22%)of the cases,and TcPO_(2) increased in 45(30%)of the cases.Angiography before treatment,and at 12 weeks after treatment,was performed in 10 of the patients and showed formation of new collateral vessels.No severe adverse effects or complications specifically related to cell transplantation were observed.Conclusion Autologous transplantation of G-CSF-mobilized PBMNCs might be a safe and effective treatment for lower limb ischemic disorder.

Can Endarterectomy Be Useful in Peripheral Arterial Occlusive Disease with Critical Limb Ischemia?

Importance of?thrombendarterectomy (TEA) had declined with the advent of bypass techniques and availability of prosthetic grafts, in patients with Peripheral arterial occlusive disease (PAOD). Recently, there had been a significant shift towards lower limb revascularization using endoluminal techniques. However, previously available data evaluating the long leg bypass or combined endoluminal and bypass procedures have been too anatomically heterogeneous to be easily applied to patients with infrainguinal disease and tissue loss. Clinical decision making in Complex multilevel or diffuse peripheral arterial occlusive disease with multiple co-morbidities especially associated coronary arterial disease is challenging. We describe twelve patients of iliofemoral arterial occlusive disease with tibiopopliteal arterial occlusive disease along with multiple co-morbidities like coronary arterial disease and diabetes mellitus who showed marked improvement with minimal post-operative?morbidities after iliofemoral or ileopopliteal bypass grafting with endarterectomy of the tibiopopliteal segment and related review of the literature.

Acute lower extremity arterial thrombosis after intraocular foreign body removal under general anesthesia: A case report and review of literature

BACKGROUND Surgery,which is a major risk factor for venous thrombosis,has rarely been considered a risk factor for arterial thrombosis.Recent studies have suggested that venous and arterial thromboses share common risk factors and have a bidirectional relationship.Accordingly,there is a growing interest in the risk of arterial thrombosis after surgery.We report a case of acute bilateral lower extremity arterial thromboses that developed after a prolonged surgery.CASE SUMMARY A 59-year-old man was hospitalized for intraocular foreign body removal surgery.He was a heavy-drinking smoker and had untreated hypertension and varicose veins in both legs.The operation was unexpectedly prolonged,lasting 4 h and 45 min.Immediately after emergence from general anesthesia,the patient complained of extreme pain in both legs.After the surgical drape was removed,cyanosis was evident in both feet of the patient.The pulse was not palpable,and continuous-wave Doppler signals were inaudible in the bilateral dorsalis pedis and posterior tibial arteries.Computed tomography angiography confirmed acute bilateral thrombotic occlusion of the popliteal arteries,proximal anterior tibial arteries,and tibioperoneal trunks.Arterial pulse returned in both lower limbs after 6 h of heparin initiation.The patient was discharged on postoperative day 26 without any sequelae.CONCLUSION Acute lower extremity arterial thrombosis can occur after surgery.Anesthesiologists should pay particular attention to patients with risk factors for thrombosis.

Hemorheology and walking of peripheral arterial occlusive diseases patients during treatment with Ginkgo biloba extract

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Randomized study comparing incidence of radial artery occlusion post-percutaneous coronary intervention between two conventional compression devices using a novel airinflation technique

AIM To compare post-percutaneous coronary intervention(PCI) radial artery occlusion(RAO) incidence between two conventional radial artery compression devices using a novel air-inflation technique.METHODS One hundred consecutive patients post-PCI were randomized 1:1 to Safeguard or TR band compression devices. Post-radial sheath removal, each compression device was inflated with additional 2 m L of air above index bleeding point during air-filled device application and gradually down-titrated accordingly. RAO was defined as absence of Doppler flow signal performed at 24 h and at 6 wk post-PCI. Patients with missing data were excluded. Statistical significance was defined as P < 0.05.RESULTS All patients had 6 F radial sheath inserted. No significant differences were observed between Safeguard Radial(n = 42) vs TR band(n = 42) in terms of age(63 ± 11 years vs 67 ± 11 years), clinical presentation(electives, n = 18 vs n = 16; acute coronary syndrome, n = 24 vs n = 26) and total procedural heparin(7778 ± 2704 IU vs 7825 ± 2450 IU). RAO incidence was not significantly different between groups at 24 h(2% vs 0%, P = 0.32) and 6 wk(0%, both).CONCLUSION Safeguard Radial and TR band did not demonstrate significant between-group differences in short-term RAO incidence. Lack of evidence of RAO in all postPCI patients at 6 wk follow-up, regardless of radial compression device indicate advantage of using the novel and pragmatic air-inflation technique. Further work is required to more accurately confirm these findings.

Coronary Artery Chronic Total Occlusion

Coronary artery chronic total occlusion(CTO)is defi ned as an occluded coronary artery segment without anterograde fl ow for at least three months.It can be classified as a“true”or“functional”CTO based on flow characteristics.In“true”CTO,there is no anterograde flow.In“functional”CTO,there is minimal anterograde flow through the occluded segment of the coronary artery.CTO is a common fi nding during coronary angiography and its prevalence may vary depending on the reported literature.Among patients without previous coronary artery bypass grafting(CABG),CTO is found in about 20–30% of the patients.CTO may develop insidiously over a period of time and involve a complex interplay between intracellular and extracellular factors,smooth muscle and foam cells,calcifi cation,and neovascularization.There is a growing body of evidence to support that CTO revascularization may improve clinical outcome when compared to medical management.Both the European and American cardiovascular societies support CTO revascularization with a class 2a recommendation(level of evidence B).Historically,due to low procedural success rate,apparent ineffi cient resource utilization,potential increase in complication rates and uncertain clinical benefi ts,only about 10–20%of patients with CTO are treated with percutaneous coronary intervention(PCI).Recent advances using novel and innovative techniques with dedicated equipment have signifi cantly improved the procedural success rate for CTO PCI to about 90%in the hands of experienced operators.With increasing interest in CTO PCI coupled with increased educational effort,CTO PCI likely will become more accessible to patients in need of CTO revascularization.Ongoing advancement in innovative techniques and equipment will continue to improve procedural success rates and reduce procedural complication rate for CTO PCI.Furthermore,there are a number of prospective clinical trials on the horizon which should help defi ne the clinical benefi ts and limitations of CTO PCI in the near future.

BridgePoint技术用于冠状动脉慢性闭塞病变介入治疗(附1例分析)

目的了解Bridge Point技术(包括Cross Boss导管及Stingray系统)特征及应用要点,分析其在冠状动脉慢性完全闭塞病变(CTO)介入治疗中的安全性和有效性。方法回顾性分析1例60岁患者的临床资料:该患者2015年1月因心绞痛入院,行冠状动脉造影示右冠状动脉慢性完全闭塞病变,使用Bridge Point技术对右冠状动脉病变进行介入治疗。结果术者使用Cross Boss导管在血管内膜下快速通过病变,并用Stingray系统使导丝成功回到血管真腔,右冠状动脉血流复通,无发生冠状动脉穿孔等并发症。造影剂用量80 m L,手术时间1.5 h,术后次日出院。术后1个月随访,心绞痛症状已缓解。结论 Bridge Point技术有助于安全及高效地开通冠状动脉慢性完全闭塞病变。

Chronic total occlusion revascularization:A complex piece to"complete"the puzzle

Treatment of coronary chronic total occlusion(CTO)with percutaneous coronary intervention(PCI)has rapidly increased during the past decades.Different strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural success.The goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently,has led to an exponential increase in the number of CTO-PCI procedures,even if are still underutilized.It has been widely demonstrated that complete coronary revascularization,achieved by either coronary artery bypass graft or PCI,is associated with prognostic improvement,in terms of increased survival and reduction of major adverse cardiovascular events.The application of“contemporary”strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit,even in highrisk patients or complex coronary anatomy with CTO.The increasing success of CTO-PCI,allowing a complete or reasonable incomplete coronary revascularization,is enabling to overcome the last great challenge of interventional cardiology,adding a“complex”piece to“complete”the puzzle.

Subintimal recanalization for non-acute occlusion of intracranial vertebral artery in an emergency endovascular procedure:A case report

BACKGROUND Endovascular recanalization of non-acute intracranial artery occlusion is technically difficult,particularly when the microwire enters the subintima.Although the subintimal tracking and re-entry technique has been well established in the endovascular treatment of coronary artery occlusion,there is limited experience with its use in intracranial occlusion due to anatomical variations and a lack of dedicated devices.CASE SUMMARY A 74-year-old man was admitted to the hospital two days after experiencing acute weakness in both lower extremities,poor speech,and dizziness.After admission,imaging revealed acute ischemic stroke and non-acute occlusion of bilateral intracranial vertebral arteries(ICVAs).On the fourth day of admission,the patient's condition deteriorated and an emergency endovascular recanalization of the left ICVA was performed.During this procedure,a microwire was advanced in the subintima of the vessel wall and successfully reentered the distal true lumen.Two stents were implanted in the subintima.The patient's Modified Rankin Scale was 1 at three months postoperatively.CONCLUSION We present a technical case of subintimal recanalization for non-acute ICVA occlusion in an emergency endovascular procedure.However,we emphasize the necessity for caution when applying the subintimal tracking approach in intracranial occlusion due to the significant dangers involved.

选择性尺动脉持续循环压迫降低老年冠状动脉介入治疗患者桡动脉闭塞的效果观察

目的 探讨选择性尺动脉持续循环压迫降低老年冠心病行冠状动脉介入治疗患者桡动脉闭塞的效果。方法 选取行冠状动脉介入治疗的450例老年冠心病患者为研究对象,采用随机数字表法分为对照组和试验组,每组225例。对照组术后采取桡动脉非闭塞性压迫,试验组在对照组基础上采用定制的脉搏波血压计进行选择性尺动脉持续循环压迫,持续4 h。比较2组患者穿刺处出血、疼痛、拇指皮温、护士工作量、延时取压率、桡动脉血流速度、术后24 h桡动脉闭塞率和狭窄率等指标。结果 2组患者穿刺处出血、疼痛、拇指皮温、护士工作量和延时取压率等指标比较,差异无统计学意义(P>0.05)。与对照组比较,试验组在解除血压计前0.5 h桡动脉血流速度较快,术后24 h桡动脉闭塞率和狭窄率较低,差异有统计学意义(P<0.05)。结论 在不增加患者出血风险、疼痛、护士工作量和延时取压率的前提下,采用定制脉搏波血压计选择性持续循环压迫4 h可以增加桡动脉血供,降低术后桡动脉闭塞率和狭窄率。

急性大血管闭塞超时间窗血管内治疗长期预后研究

目的 对比分析急性大血管闭塞患者超“时间窗”血管内治疗(EVT)联合最佳药物治疗(BMT)与单纯最佳药物治疗的长期预后。方法 纳入2021年11月至2023年7月天津市环湖医院诊断与治疗的158例急性前循环大血管闭塞患者,分别予以血管内治疗联合最佳药物治疗(EVT组,70例)和单纯最佳药物治疗(BMT组,88例),发病后12个月采用改良Rankin量表(mRS)评估神经功能预后,单因素和多因素Logistic回归分析筛查长期预后影响因素,倾向评分匹配和多重插补法行敏感性分析。结果Logistic回归分析显示,血管内治疗是超“时间窗”急性大血管闭塞患者神经功能长期预后良好(mRS评分≤2分)的保护因素(OR=3.110,95%CI:1.460~6.620;P=0.003),年龄增大(OR=0.955,95%CI:0.924~0.987;P=0.007)和高血压病史(OR=0.418,95%CI:0.187~0.936;P=0.034)是神经功能长期预后不良的危险因素。主要结局指标的敏感性分析,倾向评分匹配后分析数据集和多重插补后分析数据集均显示,EVT组患者发病后12个月预后良好率高于BMT组(倾向评分匹配后分析数据集:aOR=3.610,95%CI:1.370~9.550,P=0.010;多重插补后分析数据集:aOR=3.870,95%CI:1.780~8.440,P=0.000),与主分析结果趋势一致。结论 与单纯最佳药物治疗相比,超“时间窗”血管内治疗联合最佳药物治疗的急性大血管闭塞患者发病后12个月神经功能预后更佳。

动脉阻塞性疾病患者血浆骨形态发生蛋白-4的表达变化及其与炎症和血管损伤的相关性

目的:骨形态发生蛋白-4(bone morphogenentic protein-4,BMP4)在动脉粥样硬化(atherosclerosis,AS)的病理过程中具有重要调节作用,但相关的临床研究较少。本研究拟观察以AS为主要病理特点的动脉阻塞性疾病(arterial occlusive disease,ACD)患者血浆BMP4的表达情况,并分析血浆中BMP4与炎症因子和血管损伤标志物之间的相关性。方法:共招募38名诊断为ACD的患者(ACD组)和38名体检志愿者(对照组),抽取ACD组患者术前和对照组体检时的静脉血,比较2组血常规指标的差异。采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测血浆中BMP4、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素(interleukin,IL)-1β、IL-10及血管内皮钙黏蛋白(vascular endothelial cadherin,VE-cadherin)的表达变化,并进一步分析BMP4与以上各指标之间的相关性。结果:与对照组相比,ACD组患者血常规结果表现为中性粒细胞-淋巴细胞比值[neutrophil to lymphocyte ratio,NLR;1.63(1.26,1.91)vs 3.43(2.16,6.61)]和血小板-淋巴细胞比值[platelet to lymphocyte ratio,PLR;6.37(5.26,7.74)vs 15.79(7.97,20.53)]升高、淋巴细胞-单核细胞比值[lymphocyte to monocyte ratio,LMR;5.67(4.41,7.14)vs3.43(2.07,3.74)]下降(均P<0.05);ACD组患者血浆BMP4[581.26(389.85,735.64)pg/mL vs 653.97(510.95,890.43)pg/mL]、TNF-α[254.16(182.96,340.70)pg/mLvs293.29(238.90,383.44)pg/mL]及内皮标志物VE-cadherin[1.54(1.08,2.13)ng/mL vs 1.85(1.30,2.54)ng/mL]的水平均显著升高,而抗炎因子IL-10的水平显著下降[175.89(118.39,219.25)pg/mLvs135.92(95.80,178.04)pg/mL](均P<0.05)。2组间促炎因子IL-1β的差异无统计学意义[300.39(205.39,403.56)pg/mL vs 378.46(243.20,448.69)pg/mL;P=0.09]。相关分析结果表明:血浆BMP4水平与促炎因子IL-1β(r=0.35)、TNF-α(r=0.31)以及内皮标志物VE-cadherin(r=0.47)呈正相关,与抗炎因子IL-10呈负相关(r=-0.37;均P<0.01)。结论:ACD患者血浆BMP4的水平升高,且与患者的炎症水平和血管损伤程度具有相关性。

急性进展性前循环大血管闭塞血管内机械取栓术疗效分析

目的 探讨急性进展性前循环大血管闭塞性缺血性卒中患者血管内机械取栓术的有效性和安全性。方法 纳入2020年1月至2023年4月河北省人民医院诊断与治疗的414例急性前循环大血管闭塞性缺血性卒中患者,分别行“时间窗”内机械取栓术(时间窗内取栓组,293例)、进展性脑卒中机械取栓术(进展取栓组,45例)和标准内科治疗(内科组,76例),以治疗后3个月神经功能预后[改良Rankin量表(mRS)]作为主要结局、术后即刻血管再通率[改良脑梗死溶栓血流分级(mTICI)]作为次要结局,记录治疗后症状性脑出血发生率和3个月全因死亡率。结果 3组患者神经功能预后差异有统计学意义(χ^(2)=19.572,P=0.000),其中进展取栓组(Z=-2.829,P=0.005)和时间窗内取栓组(Z=-4.422,P=0.000)预后良好率均高于内科组,而时间窗内取栓组与进展取栓组神经功能预后差异无统计学意义(Z=-0.525,P=0.600)。Logistic回归分析显示,治疗前美国国立卫生研究院卒中量表评分高(OR=1.298,95%CI:1.216~1.385;P=0.000)和内科治疗(OR=7.572,95%CI:3.048~18.809;P=0.000)是急性前循环大血管闭塞性缺血性卒中患者预后不良的危险因素,机械取栓术是预后良好的保护因素(OR=0.431,95%CI:0.212~0.879;P=0.021)。进展取栓组与时间窗内取栓组术后即刻血管再通率差异无统计学意义(χ^(2)=0.218,P=0.640)。3组治疗后症状性脑出血发生率差异有统计学意义(χ^(2)=6.575,P=0.037),其中时间窗内取栓组高于内科组(Z=-2.376,P=0.018);3个月全因死亡率差异无统计学意义(χ^(2)=5.178,P=0.075)。结论 急性进展性前循环大血管闭塞性缺血性卒中患者行机械取栓术具有较好的疗效和安全性。

腘动脉逆行穿刺治疗股腘动脉闭塞性病变的临床研究进展

腘动脉逆行穿刺是治疗股腘动脉闭塞患者的一条重要入路选择。腘动脉逆行穿刺需在X线或超声的引导下完成,两种引导方式适用于腘动脉不同的穿刺位置。本文就腘动脉逆行穿刺治疗下肢股腘动脉闭塞性病变的临床研究进展做一综述。

颞浅动脉-大脑中动脉搭桥术治疗闭塞性脑血管疾病的现状及研究进展

闭塞性脑血管疾病的发生与动脉粥样硬化引起的血管管腔闭塞有关,导致脑供血不足,继而出现神经功能障碍。脑血管搭桥术是临床上治疗闭塞性脑血管疾病的主要手段之一,患者经治疗后可改善患侧脑供血,因此近年来该治疗方法受到广泛关注。但目前对于脑血管搭桥术在治疗闭塞性脑血管疾病中的应用还存在诸多需要探讨的问题。本文就颞浅动脉-大脑中动脉(superficial temporal artery-middle cerebral artery,STA-MCA)搭桥术在治疗闭塞性脑血管疾病中的现状及研究进展进行综述,旨在为该治疗手段在临床上的应用提供参考。

慢性颈内动脉闭塞评估及治疗中国专家共识

随着医疗诊断技术的进步及我国老年人口的不断增加,慢性颈内动脉闭塞(CICAO)在临床上越来越常见。伴有严重血流动力学障碍的症状性CICAO患者有较高的再发缺血性卒中的风险,与CICAO慢性缺血相关的认知功能障碍也越来越受到重视。但是,目前临床上对于CICAO尚缺乏统一的评估和治疗方案。该专家共识对CICAO相关的最新临床研究进行总结,并结合国内相关领域专家的临床实践经验,对CICAO患者的评估、治疗及围手术期管理提出了针对性意见,以期进一步规范临床诊疗流程,提高国内神经病学医师对CICAO患者的诊治水平。

受体动脉不同临时阻断策略在烟雾病颞浅动脉-大脑中动脉搭桥术中的应用比较

目的探讨颞浅动脉-大脑中动脉端侧吻合术中不同临时阻断技术的效果及可靠性。方法回顾性分析2015年1月—2023年4月南方医科大学南方医院神经外科收治的接受直接搭桥术治疗的烟雾病患者资料,根据临时阻断策略的不同将患者分为3组:①有垫片、多阻断夹阻断组(multi-clips+rubber pad group,M+R组);②无垫片、多阻断夹阻断组(multi-clips group,M组);③无垫片、单阻断夹阻断组(single-clip group,S组)。比较组间临时阻断时间、受体动脉切开后有无渗血、术中穿支血管损伤以及术后新发脑梗死情况。结果共355例患者、360个大脑半球纳入分析,按大脑半球统计患者360例,其中男性188例,女性172例,平均年龄为(43.8±0.7)岁。其中M+R组45例,M组191例,S组124例。3组平均阻断时间:M+R组为(37.9±9.8)min,M组为(20.9±9.0)min,S组为(11.0±3.5)min,组间差异有统计学意义(P<0.001)。阻断后受体动脉管腔内渗血以及术中穿支血管损伤发生率:M+R组为8.89%(阻断后受体动脉渗血4例),M组为14.66%(阻断后受体动脉渗血19例,术中穿支血管损伤8例,临时阻断部位有血栓形成1例),S组为5.65%(阻断后受体动脉渗血7例),组间差异无统计学意义(P>0.05)。术后新发脑梗死发生率差异无统计学意义(P>0.05)。结论单阻断夹阻断策略安全、有效,能显著缩短临时阻断时间,可以优先考虑作为颞浅动脉-大脑中动脉端侧吻合过程中的临时阻断策略。