Monsein L H, Jeffery P J, van Heerden B B, Szabo Z, Schwartz J R, Camargo E E, Chazaly J
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
AJNR Am J Neuroradiol. 1991 Nov-Dec;12(6):1045-51.
A balloon test occlusion of the internal carotid artery was performed in 11 patients with internal carotid artery aneurysms. Tolerance by patients was assessed by a combination of clinical examination; angiography; electroencephalography; 99mTc-hexamethylpropyleneamine oxime (99mTc-HMPAO) single-photon emission computed tomography (SPECT) with relative quantification; and, in four patients, 99mTc-HMPAO SPECT with absolute quantification of cerebral blood flow. During test occlusion, angiography showed a patent circle of Willis in all patients. No patient developed new clinical findings or electroencephalographic changes. The SPECT studies of five patients in whom 99mTc-HMPAO was injected during test occlusion demonstrated changes from their baseline SPECT studies. The internal carotid artery was permanently occluded in two of these patients, neither of whom became symptomatic because of the occlusion. Three patients who demonstrated no changes between baseline and test occlusion SPECT studies underwent permanent occlusion of the internal carotid artery without incident, and postoperative SPECT images were unchanged from baseline. Our preliminary results suggest that patients who have no changes between baseline and test occlusion 99mTc-HMPAO SPECT studies should have adequate collateral circulation to sustain cerebral blood flow after occlusion of the internal carotid artery if no thromboembolic episodes occur. In contrast, a patient's tolerance of permanent occlusion cannot be consistently and reliably predicted if there are changes between baseline and test occlusion SPECT studies. In these patients, absolute quantitation of cerebral blood flow is important. Greater numbers of patients are required to confirm these initial results.
对11例颈内动脉动脉瘤患者进行了颈内动脉球囊试验性闭塞。通过临床检查、血管造影、脑电图、99m锝-六甲基丙烯胺肟（99mTc-HMPAO）单光子发射计算机断层扫描（SPECT）及相对定量分析，以及对4例患者进行的99mTc-HMPAO SPECT脑血流量绝对定量分析相结合的方法评估患者的耐受性。在试验性闭塞期间，血管造影显示所有患者的Willis环通畅。没有患者出现新的临床症状或脑电图改变。5例在试验性闭塞期间注射99mTc-HMPAO的患者的SPECT研究显示与基线SPECT研究相比有变化。其中2例患者的颈内动脉被永久性闭塞，均未因闭塞而出现症状。3例基线和试验性闭塞SPECT研究之间无变化的患者接受了颈内动脉永久性闭塞，未发生意外，术后SPECT图像与基线相比无变化。我们的初步结果表明，基线和试验性闭塞99mTc-HMPAO SPECT研究之间无变化的患者，如果不发生血栓栓塞事件，应该有足够的侧支循环来维持颈内动脉闭塞后的脑血流量。相比之下，如果基线和试验性闭塞SPECT研究之间有变化，则无法始终如一地可靠预测患者对永久性闭塞的耐受性。在这些患者中，脑血流量的绝对定量分析很重要。需要更多患者来证实这些初步结果。
