Morita Shigeki, Yasaka Masahiro, Yasumori Kotaro, Oishi Yasuhisa, Takaseya Toru, Sonoda Hiromichi, Kawara Takemi
Department of Cardiovascular Surgery, National Hospital Organization of Japan, Fukuoka, Japan.
Ann Thorac Surg. 2008 Aug;86(2):448-51. doi: 10.1016/j.athoracsur.2008.04.024.
The assessment of intracranial arterial communication is important to prevent a stroke from occurring during an aortic arch operation. Bilateral axillary artery perfusion was used with the left common carotid artery perfusion for selective cerebral perfusion. A preoperative left carotid artery compression test with measurement of the left middle cerebral artery (LMCA) flow was performed to determine how safe it was to interrupt the perfusion to the left common carotid artery.
Eighteen patients who were scheduled for an aortic arch operation underwent the test. Before surgery, the LMCA flow was detected using transcranial Doppler ultrasonography. During manual compression of the left carotid artery, the flow velocity of the LMCA was measured and expressed as a percent in comparison to the precompression value.
During carotid artery compression, flow velocity of the LMCA was reduced to 56% +/- 36% (median, 63%; range, 0% to 100%) of the precompression value. The communication to the LMCA assessed with magnetic resonance angiography showed a weak relationship to the functional flow reserve of the LMCA based on a transcranial Doppler study. The results indicated that morphologic observation with magnetic resonance angiography did not reflect the dynamic nature of the intracranial collaterals.
A preoperative left carotid artery compression test with a measurement of the flow of the LMCA is useful to assess the feasibility of interrupting perfusion to the left carotid artery during aortic arch surgery with bilateral axillary artery perfusion.
评估颅内动脉交通对于预防主动脉弓手术期间发生中风很重要。采用双侧腋动脉灌注联合左颈总动脉灌注进行选择性脑灌注。术前进行左颈动脉压迫试验并测量左大脑中动脉（LMCA）血流，以确定中断左颈总动脉灌注的安全性。
18例计划行主动脉弓手术的患者接受了该试验。术前，使用经颅多普勒超声检测LMCA血流。在手动压迫左颈动脉期间，测量LMCA的血流速度，并与压迫前的值相比以百分比表示。
在颈动脉压迫期间，LMCA的血流速度降至压迫前值的56%±36%（中位数，63%；范围，0%至100%）。基于经颅多普勒研究，磁共振血管造影评估的与LMCA的交通与LMCA的功能血流储备显示出较弱的相关性。结果表明，磁共振血管造影的形态学观察并未反映颅内侧支循环的动态性质。
术前进行左颈动脉压迫试验并测量LMCA血流，对于评估在双侧腋动脉灌注的主动脉弓手术期间中断左颈动脉灌注的可行性是有用的。
