Grigor'eva E V, Luk'ianchikov V A, Tokarev A S, Krylov V V
Zh Nevrol Psikhiatr Im S S Korsakova. 2014;114(9):38-42.
To evaluate the influence of the EICMA on the circulation of the brain in patients with unilateral occlusion of the internal carotid artery (ICA) in the late postoperative period using CT perfusion.
Ten patients with unilateral internal carotid artery occlusion and stenosis of the opposite ICA 50-60%, with a history of a single ischemic stroke were examined. All patients underwent pre-and postoperative CT angiography of the brachiocephalic and intracranial arteries and CT perfusion. We also compared the results of neurological examinations preoperatively and during the year after the intervention.
The neurological data during the first year after surgery demonstrated an improvement of neurological status and quality of life in all patients. Preoperative CT perfusion showed the patchy decrease in the cerebral blood flow (CBF) to 18 ml/100 g/min (average of 44-56 ml/100 g/min) and increase in the mean transit time (MTT) to 7.2 s (normally less 6c) in all cases on the side of occlusion. The most susceptible to chronic ischemic changes was the frontal region, temporal and parietooccipital regions were affected to a lesser extent. Due to stenosis of the opposite ICA, minimum CBF of the cortex in the opposite hemisphere was 24 ml/100 g/min and MTT was increased to 5.6 s. Six months after the applying of EICMA, the significant improvement of CT perfusion was noted on the side of the anastomosis in all patients: an increase in CBF (at least 44 ml/100 g/min) and MTT reduction (up to 6.1s in the frontal region), as well as the "synchronization" of CBF and CBV in similar areas of the cerebral cortex of the right and left hemisphere.
CT perfusion in the late postoperative period after applying EICMA in patients with unilateral ICA occlusion demonstrates not only changes of the cerebral perfusion on the side of the occlusion, but also the increased collateral blood flow of the cortex in both hemispheres, which significantly improves brain blood flow generally within 6-12 months after surgery.
运用CT灌注成像评估欧洲颅外-颅内血管搭桥协会（EICMA）技术对单侧颈内动脉（ICA）闭塞患者术后晚期脑循环的影响。
对10例单侧颈内动脉闭塞且对侧ICA狭窄50%-60%、有单次缺血性卒中病史的患者进行检查。所有患者均接受了头臂和颅内动脉的术前及术后CT血管造影以及CT灌注成像检查。我们还比较了术前及干预后一年内的神经学检查结果。
术后第一年的神经学数据显示所有患者的神经状态和生活质量均有改善。术前CT灌注成像显示，所有病例中，闭塞侧脑血流量（CBF）呈斑片状下降至18 ml/100 g/min（正常为44 - 56 ml/100 g/min），平均通过时间（MTT）增加至7.2秒（正常小于6秒）。最易发生慢性缺血性改变的是额叶区域，颞叶和顶枕叶区域受影响程度较小。由于对侧ICA狭窄，对侧半球皮质的最低CBF为24 ml/100 g/min，MTT增加至5.6秒。应用EICMA技术6个月后，所有患者吻合侧的CT灌注成像均有显著改善：CBF增加（至少44 ml/100 g/min），MTT降低（额叶区域降至6.1秒），并且左右半球大脑皮质相似区域的CBF和脑血容量（CBV）“同步”。
在单侧ICA闭塞患者中应用EICMA技术后，术后晚期的CT灌注成像不仅显示了闭塞侧脑灌注的变化，还显示了双侧半球皮质侧支血流增加，这在术后6 - 12个月内显著改善了脑血流量。
