Ishikawa T, Kuroda S, Hokin K, Kamiyama H, Abe H
Department of Neurosurgical Surgery, Hokkaido University School of Medicine, Japan.
No Shinkei Geka. 1998 Sep;26(9):823-9.
The effectiveness of extracranial-intracranial arterial bypass (EC-IC bypass) surgery for patients with hemodynamic compromise still remains controversial. In the present study, we evaluated the correlation between the pre- and post-surgical cerebral hemodynamics and long-term prognosis. 28 patients and a subsequent 21 patients (41 men, eight women: mean age 59.9 [S.D. 8.6] years) with reduced cerebrovascular reserve due to steno-occlusive disease of the cerebral major arteries formed the study groups 1 and 2, respectively. Measurement of the mean hemispheric cerebral blood flow (mCBF) and the cerebral vasoreactivity (%mCVR) with an intravenous acetazolamide injection were performed by a 133Xe inhalation method and SPECT. Patients were treated with EC-IC bypass surgery and measurement of mCBF and %mCVR were made again about one month after surgery. The patients were observed for a long period (mean 44.3 months). During the follow-up period, 6 patients experienced recurrent ischemic strokes. The annual incidence of recurrent ischemic stroke was 4.4%. The patients with significantly reduced pre- and post-surgical resting mCBF of the affected hemisphere were at significantly higher risk of recurrent ischemic stroke than the patients with normal mCBF (p < 0.01). The %mCVR of the affected hemisphere rose after surgery.
颅外-颅内动脉搭桥术（EC-IC搭桥术）对血流动力学受损患者的有效性仍存在争议。在本研究中，我们评估了手术前后脑血流动力学与长期预后之间的相关性。分别因大脑主要动脉狭窄闭塞性疾病导致脑血管储备减少的28例患者以及随后的21例患者（41例男性，8例女性：平均年龄59.9[标准差8.6]岁）组成了研究组1和研究组2。采用133Xe吸入法和SPECT通过静脉注射乙酰唑胺测量平均半球脑血流量（mCBF）和脑血管反应性（%mCVR）。患者接受EC-IC搭桥手术治疗，并在术后约1个月再次测量mCBF和%mCVR。对患者进行了长期观察（平均44.3个月）。在随访期间，6例患者发生复发性缺血性卒中。复发性缺血性卒中的年发病率为4.4%。患侧半球手术前后静息mCBF显著降低的患者发生复发性缺血性卒中的风险显著高于mCBF正常的患者（p<0.01）。患侧半球的%mCVR术后升高。
