Barr J D, Lemley T J, McCann R M
Department of Radiology, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey 17033, USA.
Neurosurgery. 1998 Sep;43(3):634-7; discussion 637-8. doi: 10.1097/00006123-199809000-00144.
Clinical evaluation was combined with xenon-enhanced computed tomographic (CT) cerebral blood flow (CBF) evaluation during carotid artery balloon test occlusion (BTO), without patient transfer from the angiography suite to the CT scanner or balloon reinflation.
Thirteen patients underwent carotid artery BTO. Placement of temporary occlusion balloons was performed with patients positioned on the CT scanner table. If neurological testing revealed no changes within 10 minutes after balloon inflation, patients were positioned within the CT scanner gantry for xenon-enhanced CT CBF evaluation. CBF evaluations were begun 12 to 15 minutes after balloon inflation and required 8 minutes for completion. After completion of CBF evaluation, neurological testing continued during 30 minutes of arterial occlusion.
One patient did not tolerate BTO, with the development of reversible hemiparesis. Reliable CBF data were not obtained because of patient motion in one case. Eleven patients clinically tolerated BTO and completed CBF evaluation. For five patients, xenon-enhanced CT scanning revealed no regions with CBF of less than 30 ml/100 g/min. For four patients, xenon-enhanced CT scanning revealed small regions with CBF of less than 30 ml/100 g/min within the anterior frontal lobe on the occluded side. For two patients, ipsilateral CBF decreased dramatically during BTO, with CBF in many regions of less than 30 ml/100 g/min and in some of less than 20 ml/100 g/min.
Xenon-enhanced CT CBF evaluation can be combined with clinical testing during BTO without patient transfer, balloon reinflation, or increases in the duration of the procedure. We recognize that the value of CBF evaluation during BTO remains to be proven; our technique does, however, eliminate abbreviated clinical neurological evaluation, patient transfer, and balloon reinflation, which were previously associated with the use of xenon-enhanced CT CBF evaluation during carotid artery BTO.
在颈动脉球囊试验性闭塞（BTO）期间，将临床评估与氙增强计算机断层扫描（CT）脑血流量（CBF）评估相结合，而无需将患者从血管造影室转移至CT扫描仪或再次充盈球囊。
13例患者接受了颈动脉BTO。在患者位于CT扫描仪检查台上时放置临时闭塞球囊。如果神经学检查显示球囊充盈后10分钟内无变化，则将患者置于CT扫描仪机架内进行氙增强CT CBF评估。CBF评估在球囊充盈后12至15分钟开始，完成评估需要8分钟。CBF评估完成后，在动脉闭塞的30分钟内继续进行神经学检查。
1例患者不耐受BTO，出现可逆性偏瘫。由于1例患者运动，未获得可靠的CBF数据。11例患者临床上耐受BTO并完成CBF评估。5例患者的氙增强CT扫描显示，没有CBF低于30 ml/100 g/min的区域。4例患者的氙增强CT扫描显示，在闭塞侧额叶前部有小区域的CBF低于30 ml/100 g/min。2例患者在BTO期间同侧CBF显著下降，许多区域的CBF低于30 ml/100 g/min，有些区域低于20 ml/100 g/min。
在BTO期间，氙增强CT CBF评估可与临床检查相结合，而无需患者转移、球囊再次充盈或延长手术时间。我们认识到BTO期间CBF评估的价值仍有待证实；然而，我们的技术确实消除了先前与颈动脉BTO期间使用氙增强CT CBF评估相关的简略临床神经学评估、患者转移和球囊再次充盈。
