Hemodynamic Outcome of Successful Bypass Surgery in Patients with Atherosclerotic Cerebrovascular Disease: A study with Acetazolamide and (99m)Tc-ECD SPECT.
- Author:
Jae Seon EO
1
;
Chang Wan OH
;
Yu Kyeong KIM
;
Eun Kyung PARK
;
Won Woo LEE
;
Sang Eun KIM
Author Information
1. Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea. yk3181@snu.ac.kr
- Publication Type:Original Article
- Keywords:
atherosclerotic carotid artery stenosis;
STA-MCA anastomosis;
hemodynamic changes;
acetazolamide;
(99m)Tc-ECD SPECT
- MeSH:
Acetazolamide*;
Constriction, Pathologic;
Hemodynamics*;
Humans;
Perfusion;
Tomography, Emission-Computed, Single-Photon*
- From:Nuclear Medicine and Molecular Imaging
2006;40(6):293-301
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: The aim of the study was to evaluate the hemodynamic changes after successful bypass surgery in patients with atherosclerotic stenosis in ICA using (99m)Tc-ECD SPECT. MATERIALS AND METHODS: Fourteen patients (M:F=8:6, mean age; 60+/-9 years) who underwent STA-MCA anastomosis for unilateral atherosclerotic cerebrovascular disease were enrolled. (99m)Tc-ECD basal/acetazolamide perfusion SPECT studies were performed before, 10 days and 6 months after bypass surgery. Perfusion reserve was defined as the % changes after acetazolamide over rest image. Regional cerebral blood flow and perfusion reserve were compared preoperative, early-postoperative and late-postoperative scans. RESULTS: The mean resting perfusion and decrease in perfusion reserve in affected ICA territory on preoperative scan was 52.4+/-3.5 and -7.9+/-4.7%, respectively. The resting perfusion was significantly improved after surgery on early-postoperative scan (mean 53.7+/-2.7) and late-postoperative scan (mean 53.3+/-2.5) compared with preoperative images (p<0.05, respectively). Resting perfusion did not showed further improvement on late-postoperative scan compared with early-postoperative scan. The perfusion reserve was -3.7+/-2.6% on early-postoperative scan, and -1.6+/-2.3% on late-postoperative scan, which was significantly improved after surgery. Additionally, further improvement of perfusion reserved as observed on late-postoperative scan (p<0.05). While, in the unaffected ICA territory, no significant changes in the resting perfusion and perfusion reserve was observed. CONCLUSION: The improvement of resting perfusion and perfusion reserve in early-postoperative scan reflects the immediate restoration of the cerebral blood flow by bypass surgery. In contrasts, further improvement of perfusion reserve showing on late-postoperative scan may indicate a good collateral development after surgery, which may indicate good surgical outcome after surgery.
