Amin-Hanjani Sepideh, Du Xinjian, Mlinarevich Nada, Meglio Guido, Zhao Meide, Charbel Fady T
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois 60612-5970, USA.
Neurosurgery. 2005 Jan;56(1 Suppl):75-85; discussion 75-85. doi: 10.1227/01.neu.0000143032.35416.41.
There has been a resurgence of interest in selective extracranial-intracranial bypass for revascularization of cerebrovascular occlusive disease. We evaluated the usefulness of intraoperative blood flow measurements in predicting graft success after extracranial-intracranial bypass.
A retrospective review of 51 cases of extracranial-intracranial bypass for purposes of flow augmentation in the setting of cerebrovascular occlusive disease was performed. In all cases, free flow from the cut end of the donor vessel, termed cut flow, was measured. The cut flow index (CFI) (bypass flow [ml/min] / cut flow [ml/min]) was derived and correlated with bypass patency, postoperative bypass flow, cerebrovascular reserve testing, and clinical outcome.
The CFI was a significant predictor of bypass patency (P = 0.002). Using a CFI of 0.5 as a threshold, the bypass patency rate was 92% in cases with a CFI greater than 0.5 compared with 50% in cases with a CFI less than 0.5. Intraoperative bypass flow correlated well with postoperative measurements obtained from quantitative phase-contrast magnetic resonance imaging. An analysis of cases with a poor CFI indicated that a logical interpretation of bypass function can be performed during surgery.
A poor CFI can alert surgeons to potential difficulties with the donor vessel, anastomosis, or recipient vessel during surgery. Furthermore, a CFI closely approximating 1.0 provides physiological confirmation of impaired cerebrovascular reserve in the recipient bed.
选择性颅外 - 颅内搭桥术用于脑血管闭塞性疾病血运重建的研究再度兴起。我们评估了术中血流测量在预测颅外 - 颅内搭桥术后移植物成功方面的作用。
对51例因脑血管闭塞性疾病进行颅外 - 颅内搭桥以增加血流的病例进行回顾性研究。在所有病例中，测量供体血管断端的自由血流，即断流。计算断流指数（CFI）（搭桥血流量[毫升/分钟] / 断流[毫升/分钟]），并将其与搭桥通畅情况、术后搭桥血流量、脑血管储备测试及临床结果进行关联。
CFI是搭桥通畅的重要预测指标（P = 0.002）。以CFI为0.5作为阈值，CFI大于0.5的病例搭桥通畅率为92%，而CFI小于0.5的病例为50%。术中搭桥血流量与定量相位对比磁共振成像获得的术后测量结果相关性良好。对CFI不佳的病例分析表明，术中可对搭桥功能进行合理评估。
CFI不佳可提醒外科医生手术过程中供体血管、吻合口或受体血管可能存在的困难。此外，CFI接近1.0可从生理角度证实受体床脑血管储备受损。
