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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.

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