Gibbs J M, Wise R J, Thomas D J, Mansfield A O, Russell R W
J Neurol Neurosurg Psychiatry. 1987 Feb;50(2):140-50. doi: 10.1136/jnnp.50.2.140.
Regional cerebral blood flow, oxygen utilisation, fractional oxygen extraction, and cerebral blood volume were measured by positron emission tomography in twelve patients with carotid artery occlusion. Follow-up studies were carried out at a mean interval of eleven weeks after extracranial-intracranial bypass surgery. Clinical improvement was observed in three patients who had presented with frequent transient ischaemic attacks. One patient with multiple vascular occlusions suffered a stroke at the time of surgery. Follow-up studies showed an increase of regional cerebral blood flow in only two of the twelve patients. In the group as a whole, there was no significant change of cerebral blood flow, oxygen consumption or fractional oxygen extraction after bypass surgery. The most consistent post-operative change, observed in eleven of the twelve patients, was a fall of cerebral blood volume in the cortical territory of the bypassed carotid artery (p less than 0.01). This effect was most marked in patients with bilateral carotid occlusion, in whom there was often an accompanying fall of blood volume in the contralateral hemisphere. The post-operative findings were consistent with an increase of regional cerebral perfusion pressure as a result of the bypass procedure. Although this effect is potentially of value, those patients with most to gain from bypass surgery may also run the highest risk of peri-operative cerebral ischaemia.
采用正电子发射断层扫描术对12例颈动脉闭塞患者的局部脑血流量、氧利用率、氧摄取分数和脑血容量进行了测量。在颅外 - 颅内搭桥手术后平均11周的时间间隔进行了随访研究。3例曾频繁出现短暂性脑缺血发作的患者出现了临床症状改善。1例有多发性血管闭塞的患者在手术时发生了中风。随访研究显示，12例患者中只有2例局部脑血流量增加。在整个研究组中，搭桥手术后脑血流量、氧耗量或氧摄取分数均无显著变化。在12例患者中的11例观察到的最一致的术后变化是，在搭桥的颈动脉皮质区域脑血容量下降（p < 0.01）。这种效应在双侧颈动脉闭塞的患者中最为明显，这些患者对侧半球的血容量往往也会随之下降。术后的研究结果与搭桥手术导致局部脑灌注压升高相一致。虽然这种效应可能有价值，但那些最能从搭桥手术中获益的患者也可能面临围手术期脑缺血的最高风险。
