Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
J Stroke Cerebrovasc Dis. 2020 Jun;29(6):104807. doi: 10.1016/j.jstrokecerebrovasdis.2020.104807. Epub 2020 Apr 13.
Balloon test occlusion (BTO) is performed to evaluate ischemic tolerance for large and giant cerebral aneurysms and head and neck tumors that may require parent artery occlusion. However, ischemic tolerance for the temporary test occlusion does not always guarantee a tolerance for permanent occlusion. In this study, we evaluated the utility of computed tomography (CT) perfusion during BTO to quantify ischemic tolerance for detecting delayed ischemic stroke.
Forty-one patients who underwent BTO for the internal carotid artery were included. The correlations between the parameters of CT perfusion and collateral angiographic appearance or stump pressure during BTO were evaluated. The cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT), and time to peak (TTP) were obtained through CT perfusion, and the asymmetry ratios were determined. Collateral angiographic appearances were categorized into 5 grades (0-4).
The collateral angiographic appearance showed moderate correlations with CBF, MTT, and TTP that was significant. Of these, the absolute value of the correlation coefficient was the highest for MTT. MTT also showed a moderate correlation with stump pressure. CBF and MTT were significantly different between the poor collateral group (grades 2 and 3) and the good collateral group (grade 4). Based on the MTT, the good collateral group was identified with high sensitivity (75.0%) and specificity (81.2%).
In BTO, the MTT obtained through CT perfusion showed a correlation with collateral angiographic appearance and stump pressure. Thus, the MTT might be useful to quantify ischemic tolerance for detecting delayed ischemic stroke.
球囊试验闭塞（BTO）用于评估可能需要闭塞母动脉的大型和巨大脑动脉瘤和头颈部肿瘤的缺血耐受能力。然而，临时试验闭塞的缺血耐受能力并不总是保证永久闭塞的耐受能力。在这项研究中，我们评估了 BTO 期间 CT 灌注在量化缺血耐受能力以检测迟发性缺血性卒中方面的效用。
纳入 41 例行 BTO 治疗颈内动脉的患者。评估了 CT 灌注的参数与 BTO 期间侧支血管造影表现或残端压力之间的相关性。通过 CT 灌注获得脑血流量（CBF）、脑血容量、平均通过时间（MTT）和达峰时间（TTP），并确定不对称比。侧支血管造影表现分为 5 个等级（0-4）。
侧支血管造影表现与 CBF、MTT 和 TTP 呈中度相关，具有统计学意义。其中，MTT 的相关系数绝对值最高。MTT 与残端压力也呈中度相关。CBF 和 MTT 在侧支循环不良组（等级 2 和 3）和侧支循环良好组（等级 4）之间存在显著差异。基于 MTT，侧支循环良好组具有较高的灵敏度（75.0%）和特异性（81.2%）。
在 BTO 中，通过 CT 灌注获得的 MTT 与侧支血管造影表现和残端压力呈相关性。因此，MTT 可能有助于量化缺血耐受能力以检测迟发性缺血性卒中。
