Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, China.
Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, China.
Eur Radiol. 2018 Feb;28(2):727-735. doi: 10.1007/s00330-017-5020-8. Epub 2017 Sep 11.
To investigate the relationship between the level of collateral circulation and perfusion territory normalisation after carotid endarterectomy (CEA).
This study enrolled 22 patients with severe carotid stenosis that underwent CEA and 54 volunteers without significant carotid stenosis. All patients were scanned with ASL and t-ASL within 1 month before and 1 week after CEA. Collateral circulation was assessed on preoperative ASL images based on the presence of ATA. The postoperative flow territories were considered as back to normal if they conformed to the perfusion territory map in a healthy population. Neuropsychological tests were performed on patients before and within 7 days after surgery.
ATA-based collateral score assessed on preoperative ASL was significantly higher in the flow territory normalisation group (n=11, 50 %) after CEA (P < 0.0001). The MMSE (mean change=1.36±0.96) and MOCA (mean change=1.18±0.95) test scores showed a significant postoperative (7 days after CEA) improvement in the flow territory normalisation group [>mean differences+2SD among control (MMSE=1.35, MOCA=1.02)].
This study demonstrated that effective collateral flow in carotid stenosis patients was associated with normalisation of t-ASL perfusion territory after CEA. The perfusion territory normalisation group tends to have more cognitive improvement after CEA.
• Evaluation of collaterals before CEA is helpful for avoiding ischaemia during clamping. • There was good agreement on ATA-based ASL collateral grading. • Perfusion territories in carotid stenosis patients are altered. • Patients have better collateral circulation with perfusion territory back to normal. • MMSE and MOCA test scores improved more in the territory normalisation group.
探讨颈动脉内膜切除术（CEA）后侧支循环水平与灌注区正常化的关系。
本研究纳入了 22 例严重颈动脉狭窄接受 CEA 的患者和 54 例无明显颈动脉狭窄的志愿者。所有患者均在 CEA 前 1 个月和术后 1 周内进行 ASL 和 t-ASL 扫描。基于存在 ATA 对术前 ASL 图像进行侧支循环评估。如果术后血流区域符合健康人群的灌注区域图，则认为其恢复正常。在手术前和手术后 7 天内对患者进行神经心理学测试。
CEA 后，血流区域正常化组（n=11，50%）的基于 ASL 的 ATA 侧支循环评分显著升高（P<0.0001）。MMSE（平均变化=1.36±0.96）和 MoCA（平均变化=1.18±0.95）测试评分显示，血流区域正常化组在 CEA 后 7 天（手术后）有显著的改善[>对照组的平均值差异+2SD（MMSE=1.35，MoCA=1.02）]。
本研究表明，颈动脉狭窄患者有效的侧支血流与 CEA 后 t-ASL 灌注区的正常化有关。灌注区正常化组在 CEA 后更倾向于认知功能改善。
CEA 前评估侧支循环有助于避免夹闭期间缺血。
基于 ASL 的 ATA 侧支分级具有良好的一致性。
颈动脉狭窄患者的灌注区发生改变。
患者具有更好的侧支循环，灌注区恢复正常。
MMSE 和 MoCA 测试评分在区域正常化组中改善更多。
