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Cerebral haemodynamic changes after extracranial-intracranial bypass surgery
Journal of Neurology, Neurosurgery, and Psychiatry
|February 1, 1987
Summary
Extracranial-intracranial bypass surgery for carotid artery occlusion did not significantly alter overall cerebral blood flow or oxygen use. However, it consistently reduced cerebral blood volume in the bypassed area, potentially increasing perfusion pressure.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Surgery
Background:
- Carotid artery occlusion poses a risk for ischemic stroke.
- Extracranial-intracranial (EC-IC) bypass surgery is a treatment option for selected patients.
- Assessing the hemodynamic effects of EC-IC bypass is crucial for understanding its efficacy.
Purpose of the Study:
- To evaluate the impact of EC-IC bypass surgery on regional cerebral blood flow (rCBF), oxygen utilization, fractional oxygen extraction (FOE), and cerebral blood volume (CBV).
- To correlate post-operative hemodynamic changes with clinical outcomes in patients with carotid artery occlusion.
Main Methods:
- Positron emission tomography (PET) was used to measure rCBF, oxygen utilization, FOE, and CBV.
- Measurements were taken in twelve patients with carotid artery occlusion before and after EC-IC bypass surgery.
- Clinical assessments were performed to evaluate patient improvement.
Main Results:
- No significant group changes in rCBF, oxygen consumption, or FOE were observed post-surgery.
- A significant decrease in CBV was consistently found in the cortical territory of the bypassed carotid artery (p < 0.01) in eleven of twelve patients.
- Clinical improvement occurred in three patients with transient ischemic attacks; one patient suffered a stroke peri-operatively.
Conclusions:
- EC-IC bypass surgery may increase regional cerebral perfusion pressure, indicated by reduced CBV, but does not consistently improve overall cerebral blood flow.
- Patients with severe carotid occlusion who might benefit most from bypass surgery may also face the highest risk of peri-operative cerebral ischemia.
- Careful patient selection is essential for EC-IC bypass surgery in carotid artery occlusion.