Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Eur J Cardiothorac Surg. 2019 Jun 1;55(6):1079-1085. doi: 10.1093/ejcts/ezy450.
Optimal methods to quantitatively evaluate the blood flow in each cerebral artery after zone 1-2 thoracic endovascular aortic repair (TEVAR) remain unknown. Our objective was to evaluate the differences between preoperative and postoperative cerebral artery blood flows after zone 1-2 debranching TEVAR (dTEVAR).
Between January 2016 and August 2018, a prospective analysis of the blood flow in both the internal carotid artery and the vertebral artery in 16 patients before and after zone 1-2 dTEVAR was conducted. Zone 1 dTEVAR with right axillary artery-left common carotid artery-left axillary artery (RAxA-LCCA-LAxA) bypass was performed on 7 patients. Zone 2 dTEVAR was performed on 9 patients: 4 underwent RAxA-LAxA bypass and 5 underwent LCCA-LAxA bypass. Quantitative magnetic resonance angiography was performed before and after zone 1-2 dTEVAR.
Total intracranial blood flow was preserved postoperatively [The median (interquartile range) preoperatively vs postoperatively: 621 (549-686) vs 638 (539-703) ml/min, not significant]. The anterior [469 (400-504) vs 475 (404-510) ml/min, not significant] and posterior cerebral blood flows [157 (121-199) vs 163 (123-210) ml/min, not significant] were also maintained postoperatively. In the 3 debranching procedures, the postoperative anterior and posterior cerebral blood flows were maintained at rates similar to preoperative rates, with the proportion of anterior and posterior cerebral circulations reaching almost 75% and 25%, respectively. No significant differences between preoperative and postoperative distributions of internal carotid artery blood flows were observed. Regarding vertebral artery blood flows, the distribution of blood flow through the left vertebral artery was significantly lower postoperatively than preoperatively; however, the postoperative right vertebral artery blood flow distribution significantly increased compared with the preoperative flow.
In zone 1-2 dTEVAR, total intracranial blood flow was preserved postoperatively, and the postoperative anterior and posterior cerebral circulations were maintained at rates similar to their preoperative rates.
目前尚不清楚用于定量评估 1-2 区胸主动脉腔内修复术（TEVAR）后各脑动脉血流的最佳方法。本研究旨在评估 1-2 区去分支 TEVAR（dTEVAR）前后脑动脉血流的差异。
2016 年 1 月至 2018 年 8 月，前瞻性分析了 16 例 1-2 区 dTEVAR 前后颈内动脉和椎动脉的血流情况。7 例患者行 1 区 dTEVAR 加右腋动脉-左颈总动脉-左腋动脉（RAxA-LCCA-LAxA）旁路术，9 例患者行 2 区 dTEVAR：4 例行 RAxA-LAxA 旁路术，5 例行 LCCA-LAxA 旁路术。1-2 区 dTEVAR 前后均行定量磁共振血管造影。
术后全脑血流量得以保留[术前（中位数（四分位间距））与术后：621（549-686）与 638（539-703）ml/min，无显著差异]。前脑[469（400-504）与 475（404-510）ml/min，无显著差异]和后脑[157（121-199）与 163（123-210）ml/min，无显著差异]也得到了维持。在 3 个去分支手术中，术后前脑和后脑血流维持在与术前相似的水平，前脑循环和后脑循环的比例分别达到近 75%和 25%。术前和术后颈内动脉血流分布无显著差异。椎动脉血流方面，术后左椎动脉血流分布明显低于术前；然而，术后右椎动脉血流分布明显高于术前。
在 1-2 区 dTEVAR 中，术后全脑血流量得以保留，术后前脑和后脑循环保持在与术前相似的水平。
