Tomura Noriaki, Omachi Koichi, Takahashi Satoshi, Sakuma Ikuo, Otani Takahiro, Watarai Jiro, Ishikawa Kazuo, Kinouchi Hiroyuki, Mizoi Kazuo
Department of Radiology, Akita University School of Medicine, 1-1-1, Hondo, Akita City, Akita 010-8543, Japan.
AJNR Am J Neuroradiol. 2005 Sep;26(8):1937-42.
Measuring blood pressure (stump pressure) in the distal internal carotid artery during occlusion of the internal carotid artery is reportedly a reliable safety index with which to predict ischemia following permanent occlusion of the internal carotid artery. We compared the stump pressure during occlusion of the internal carotid artery with single-photon emission CT (SPECT) using technetium Tc 99m hexamethylpropyleneamine oxime (HMPAO).
Twenty-seven patients underwent the balloon occlusion test. After occlusion of the internal carotid artery was performed by a balloon catheter, technetium Tc 99m HMPAO was injected, and then the balloon remained inflated for 15 minutes. The stump pressure was continuously monitored for those 15 minutes. After the balloon catheter was deflated and removed, SPECT was performed. Sixty-four symmetric pairs of regions of interest were set on both sides of the cerebral hemisphere. The radioactivity count ratio (L/n ratio) of the occluded side to the contralateral normal side was calculated. We defined hypoperfusion as an area with an L/n ratio <0.8. The minimum mean stump pressure (minMSP) during the balloon occlusion test and the pressure ratio of the minMSP to the mean systemic pressure were compared with the hypoperfusion area on SPECT.
The number of regions of interest with hypoperfusion was significantly (P < .001) greater in patients with a minMSP <40 mm Hg (mean [+/-SD] = 31.5 +/- 13.7) than in patients with a minMSP > or =40 mm Hg (5.1 +/- 4.0). The number of regions of interest with hypoperfusion was also significantly (P < .001) greater in patients with a pressure ratio <0.5 (26.7 +/- 15.8) than in patients with a pressure ratio > or =0.5 (4.5 +/- 3.5).
The minMSP during the balloon test occlusion reflects the extent of the hypoperfused area measured by SPECT using technetium Tc 99m HMPAO.
据报道，在颈内动脉闭塞期间测量颈内动脉远端的血压（残端压力）是预测颈内动脉永久性闭塞后缺血的可靠安全指标。我们使用锝 Tc 99m 六甲基丙烯胺肟（HMPAO），将颈内动脉闭塞期间的残端压力与单光子发射计算机断层扫描（SPECT）进行了比较。
27 例患者接受了球囊闭塞试验。通过球囊导管闭塞颈内动脉后，注射锝 Tc 99m HMPAO，然后球囊保持充盈 15 分钟。在这 15 分钟内持续监测残端压力。球囊导管放气并移除后，进行 SPECT 检查。在大脑半球两侧设置了 64 对对称的感兴趣区域。计算闭塞侧与对侧正常侧的放射性计数比（L/n 比）。我们将灌注不足定义为 L/n 比<0.8 的区域。将球囊闭塞试验期间的最低平均残端压力（minMSP）以及 minMSP 与平均体循环压力的比值与 SPECT 上的灌注不足区域进行比较。
minMSP<40 mmHg（平均值[±标准差]=31.5±13.7）的患者中，灌注不足的感兴趣区域数量显著（P<.001）多于 minMSP≥40 mmHg 的患者（5.1±4.0）。压力比<0.5（26.7±15.8）的患者中，灌注不足的感兴趣区域数量也显著（P<.001）多于压力比≥0.5 的患者（4.5±3.5）。
球囊试验闭塞期间的 minMSP 反映了使用锝 Tc 99m HMPAO 通过 SPECT 测量的灌注不足区域的范围。
