Meyer J S, Nakajima S, Okabe T, Amano T, Centeno R, Len Y Y, Levine J, Levinthal R, Rose J
Stroke. 1982 Nov-Dec;13(6):774-84. doi: 10.1161/01.str.13.6.774.
Regional cerebral blood flow and vasomotor reactivity were measured in 33 patients with surgically remediable hemispheric ischemia by the 133Xe inhalation method prior to superficial temporal to middle cerebral artery (STA-MCA) by-pass. Thirteen patients also underwent LCBF and L lambda measurements by the stable xenon CT method for comparison. Twenty-four had proximal occlusion of one or both internal carotid arteries, 9 had intracranial occlusive disease (4 internal carotid, 5 middle cerebral). Measurements were repeated at intervals up to 30 months following surgery and compared to measurements in a similar group (N = 13) treated medically. In the surgically treated group 22 patients had recurrent TIAs, of whom 12 also had minor residual neurological deficits from recent small cerebral infarctions with potential for recovery (RINDs) while the remaining 11 had RINDs without TIAs. After surgery 28 improved with cessation of TIAs and/or neurological recovery, 3 remained unchanged, 2 cases worsened. Compared to age-matched normal hemispheric F1 (gray matter) values, pre-operative F1 values in the STA-MCA group were reduced in both ischemic and opposite hemispheres. Ischemic regions showed imparied vasomotor reactivity to 5% CO2 or 100% O2 inhalation. After surgery, mean hemispheric F1 values increased + 12.8% on the by-pass side and + 10.5% on the contralateral side. Mean F1 increases reached a maximum 3 months after by-pass, most evident in ipsilateral frontal regions (+ 24.2%). Vasomotor reactivity did not significantly improve. Medically treated cases did not show similar F1 increases. Thirteen with carotid occlusive disease (8 with TIAs, 5 with small recent infarcts) underwent CT LCBF and L lambda measurements before and after STA-MCA by-pass. Cases with recent infarcts showed reduced LCBF and L lambda values which increased significantly after STA-MCA by-pass, however the total group operated upon showed only trends for CBF increases, probably due to large standard deviations encountered in serial measurements.
在33例可通过手术治疗的半球缺血患者中，于颞浅动脉至大脑中动脉（STA-MCA）搭桥术前，采用吸入¹³³Xe法测量局部脑血流量和血管运动反应性。13例患者还采用稳定氙CT法进行局部脑血流量（LCBF）和Lλ测量以作比较。24例患者一侧或双侧颈内动脉近端闭塞，9例患有颅内闭塞性疾病（4例颈内动脉，5例大脑中动脉）。术后间隔长达30个月重复测量，并与一组接受药物治疗的类似患者（N = 13）的测量结果进行比较。在手术治疗组中，22例患者有短暂性脑缺血发作（TIA）复发，其中12例因近期小的脑梗死遗留轻微神经功能缺损且有恢复可能（可逆性缺血性神经功能缺损，RIND），其余11例有RIND但无TIA。术后28例病情改善，TIA停止发作和/或神经功能恢复，3例无变化，2例病情恶化。与年龄匹配的正常半球F1（灰质）值相比，STA-MCA组术前缺血半球和对侧半球的F1值均降低。缺血区域对吸入5%二氧化碳或100%氧气的血管运动反应受损。术后，搭桥侧半球平均F1值增加12.8%，对侧增加10.5%。平均F1增加在搭桥后3个月达到最大值，在同侧额叶区域最为明显（增加24.2%）。血管运动反应性未显著改善。药物治疗的病例未显示出类似的F1增加。13例患有颈动脉闭塞性疾病的患者（8例有TIA，5例近期有小梗死）在STA-MCA搭桥术前和术后进行了CT LCBF和Lλ测量。近期有梗死的病例显示LCBF和Lλ值降低，STA-MCA搭桥术后显著增加，然而，整个手术组仅显示出脑血流量增加的趋势，可能是由于连续测量中遇到的标准差较大。
