Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe University Hospital, Kobe, Japan.
Department of Neurosurgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan.
World Neurosurg. 2019 Oct;130:e899-e907. doi: 10.1016/j.wneu.2019.07.033. Epub 2019 Jul 10.
There has been no effective method to predict ischemic intolerance to temporary internal carotid artery (ICA) occlusion during carotid artery reconstruction. Pencil beam presaturation (BeamSAT) pulse suppresses the flow signal of the target vessel in magnetic resonance angiography (MRA). Applying this method, we constructed ICA-selective MRA images. The aim of this study was to identify patients at risk for ischemic intolerance by ICA-selective MRA.
By evaluating flow of anterior communicating artery (Acom) and A1 portion of anterior cerebral artery with ICA-selective MRA and posterior communicating artery (Pcom) with conventional MRA, we investigated associations of these collateral flow patterns with ischemic intolerance and decrease of regional cerebral oxygen saturation.
The study included 58 patients who underwent carotid endarterectomy or carotid artery stenting. Six of 7 patients without Acom flow and Pcom flow demonstrated ischemic intolerance, whereas all patients (n = 51) with Acom and/or Pcom flow demonstrated tolerance. The accuracy of this prediction model according to Acom and Pcom flow patterns for ischemic intolerance was 0.98 (P = 0.01, binomial test). Regional cerebral oxygen saturation decrease after ICA occlusion was significantly larger in patients without Acom flow and Pcom flow (12.0% ± 6.0%) than in patients with Acom flow and Pcom flow (3.0% ± 3.1%, P < 0.01) and in patients with Acom flow but no Pcom flow (2.4% ± 5.2%, P < 0.01).
These findings support the importance of Acom flow as a collateral route. ICA-selective MRA enables prediction of ischemic intolerance to temporary ICA occlusion during carotid endarterectomy or carotid artery stenting. This method provides valuable information regarding probability of an ischemic complication.
目前还没有有效的方法可以预测颈动脉重建期间临时颈内动脉（ICA）闭塞引起的缺血不耐受。铅笔束预饱和（BeamSAT）脉冲在磁共振血管造影（MRA）中抑制目标血管的血流信号。应用该方法，我们构建了 ICA 选择性 MRA 图像。本研究的目的是通过 ICA 选择性 MRA 识别有缺血不耐受风险的患者。
通过评估 ICA 选择性 MRA 中前交通动脉（Acom）和大脑前动脉 A1 段的血流以及常规 MRA 中后交通动脉（Pcom）的血流，我们研究了这些侧支血流模式与缺血不耐受和局部脑氧饱和度降低的关系。
该研究纳入了 58 例行颈动脉内膜切除术或颈动脉支架置入术的患者。7 例无 Acom 血流和 Pcom 血流的患者中有 6 例出现缺血不耐受，而所有有 Acom 和/或 Pcom 血流的患者（n=51）均耐受。根据 Acom 和 Pcom 血流模式预测缺血不耐受的准确率为 0.98（P=0.01，二项式检验）。ICA 闭塞后局部脑氧饱和度下降在无 Acom 血流和 Pcom 血流的患者中明显大于有 Acom 血流和 Pcom 血流的患者（12.0%±6.0%比 3.0%±3.1%，P<0.01）和有 Acom 血流但无 Pcom 血流的患者（2.4%±5.2%，P<0.01）。
这些发现支持 Acom 血流作为侧支循环的重要性。ICA 选择性 MRA 能够预测颈动脉内膜切除术或颈动脉支架置入术中临时 ICA 闭塞引起的缺血不耐受。该方法提供了与缺血性并发症发生概率相关的有价值信息。
