Otte A, Ostwald E, Rem J A, Götze M, Radü E W, Müller-Brand J
Institut für Nuklearmedizin, Universitätskliniken, Kantonsspital, Base, Schweiz.
Nuklearmedizin. 1997 Jan;36(1):23-8.
In a study of patients with unilateral and symptomatic stenosis of the internal carotid artery (ICA), the effect of endarterectomy (EA) on the regional cerebral blood flow (rCBF) was tested over a postoperative interval of 12 months.
Xenon-133-rCBF was assessed in 74 patients pre- and post-surgery (one week, six weeks, three months and 12 months after EA). This was done at rest and after stimulation with acetazolamide in order to test the perfusion reserve.
Before surgery all 74 patients showed a diminished perfusion ipsilaterally-at rest and/or after stimulation. 38/74 (51%) patients had a significant (> 5%) and 36/74 (49%) patients a non-significant (< 5%) interhemispheric perfusion asymmetry. Twelve months after EA, there were only 23/74 (31%) patients with significant interhemispheric perfusion asymmetry. By stimulation, this decreasing effect became more evident: Before surgery 44/74 (60%) patients had a significant interhemispheric perfusion asymmetry, 12 months after surgery there were only 14/74 (19%) patients.
In regard to the brain hemisphere distal to the ICA stenosis, our study revealed a significant improvement of brain perfusion after EA. Brain perfusion was stable over an interval of 12 months post-surgery. By EA, especially the perfusion reserve increased, as shown by a normal acetazolamide test. Hence, Xenon-133-rCBF could be shown to be an important method in the evaluation of the indication for surgery and of the result of it. In the intra-individual follow-up after EA, rCBF was able to identify hypoperfusion and may help decide, whether re-angiography is necessary or not.
在一项针对单侧有症状的颈内动脉（ICA）狭窄患者的研究中，检测了内膜切除术（EA）在术后12个月期间对局部脑血流量（rCBF）的影响。
对74例患者在手术前及手术后（EA术后1周、6周、3个月和12个月）进行了氙-133-rCBF评估。评估在静息状态下以及使用乙酰唑胺刺激后进行，以测试灌注储备。
手术前，所有74例患者在静息状态下和/或刺激后同侧灌注均减少。38/74（51%）的患者存在显著（>5%）的半球间灌注不对称，36/74（49%）的患者存在非显著（<5%）的半球间灌注不对称。EA术后12个月，只有23/74（31%）的患者存在显著的半球间灌注不对称。通过刺激，这种下降效应变得更加明显：手术前44/74（60%）的患者存在显著的半球间灌注不对称，手术后12个月只有14/74（19%）的患者。
关于ICA狭窄远端的脑半球，我们的研究显示EA术后脑灌注有显著改善。术后12个月期间脑灌注稳定。通过EA，尤其是灌注储备增加，乙酰唑胺试验正常即表明了这一点。因此，氙-133-rCBF可被证明是评估手术指征及其结果的重要方法。在EA后的个体随访中，rCBF能够识别灌注不足，并可能有助于决定是否需要再次进行血管造影。
