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Long-term noninvasive single photon emission computed tomography monitoring of perfusional changes after EC-IC bypass
V Di Piero1, G L Lenzi, M Collice
1Department of Neurological Sciences, University of Rome, Italy.
Insights
Extracranial-intracranial (EC-IC) bypass surgery for internal carotid artery (ICA) occlusion showed temporary rCBF increases. However, long-term monitoring revealed no lasting perfusion improvement after bypass surgery.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Internal carotid artery (ICA) occlusion can lead to reduced cerebral blood flow (rCBF) and neurological deficits.
- Extracranial-intracranial (EC-IC) bypass surgery is a potential treatment to restore perfusion in affected brain regions.
Purpose of the Study:
- To evaluate the long-term effects of EC-IC bypass surgery on regional cerebral blood flow (rCBF) in patients with ICA occlusion.
- To assess the durability of perfusion improvements following EC-IC bypass.
Main Methods:
- Utilized I-123 HIPDM and single photon emission computed tomography (SPECT) to measure rCBF.
- Included 14 patients with ICA occlusion undergoing EC-IC bypass surgery.
- Performed follow-up SPECT scans at 6 and 12 months post-surgery, with angiographic control of bypass patency.
Main Results:
- Pre-surgery assessment revealed cortical hypoperfusion in affected hemispheres.
- An initial increase in rCBF was observed in six patients shortly after EC-IC bypass.
- No significant rCBF changes were detected at 6 and 12-month follow-ups, despite patent bypasses.
Conclusions:
- Short-term rCBF increases after EC-IC bypass may not translate to long-lasting perfusion improvements.
- Noninvasive tomographic monitoring suggests limited long-term benefit in perfusion following EC-IC bypass surgery for ICA occlusion.
Abstract:
The rCBF was evaluated using I-123 HIPDM and single photon emission computed tomography (SPECT) on 14 patients undergoing extracranial-intracranial (EC-IC) bypass surgery because of internal carotid artery (ICA) occlusion. Before surgery, all patients showed cortical areas of hypoperfusion over the affected cerebral hemisphere. Shortly after EC-IC bypass a rCBF increase was observed in six patients. However, at the 6 and 12 month follow-ups, with angiographic control of bypass patency, rCBF studies did not show any significant rCBF change. Long-term noninvasive tomographic monitoring of perfusion changes occurring after EC-IC bypass surgery failed to show a long-lasting improvement in perfusion.