title: [Local cerebral blood flow and its CO2 reactivity in the ischemic cerebrovascular diseases before and after bypass].
abstract: We evaluated the effects of the STA-MCA anastomosis on local cerebral blood flow (LCBF) and CO2 cerebrovascular reactivity (CVR) in ischemic cerebrovascular diseases (CVD). [Patients and Methods] We examined the LCBF and CVR of 21 patients with ischemic CVD subjected standard STA-MCA anastomosis. During surgery, LCBF was continuously measured using the thermal diffusion method sometimes in a state of decreased PaCO2 (median: 7.2mmHg) before and after bypass. CVR was represented as % delta LCBF/delta CO2. [Results] 1) In the control group (with non-ruptured aneurysm, n = 7), LCBF was 58.6 +/- 14.1 ml/100g/min and % delta LCBF/delta CO2 was 4.68 +/- 1.68%/mmHg. 2) Before bypass, LCBF was 46.7 +/- 10.3ml/100g/min. It was significantly (p < 0.05) lower than control level. After bypass, LCBF increased significantly (p < 0.05) to 62.0 +/- 14.3 ml/100g/min. 3) Before bypass, % delta LCBF/delta CO2 was -1.36 +/- 4.34%/mmHg. In the 14 cases (66.7%), % delta LCBF/delta CO2 was below the 0%/mmHg (inverse steal effect). 4) After bypass, it increased to 0.08 +/- 2.73%/mmHg. 11 cases (52.4%) showed % delta LCBF/delta CO2 was above the 0%/mmHg. 5) In the group with a preoperative % delta LCBF/delta CO2 of less than 0%/mmHg, preoperative LCBF was 43.6 +/- 9.3 ml/100g/min, which was significantly low (p < 0.01) compared to that in the group with higher % delta LCBF/delta CO2. After bypass, LCBF and % delta LCBF/delta CO2 remarkably increased in the group with % delta LCBF/delta CO2 below 0%/mmHg. [Conclusion] Before bypass, LCBF was low and CVR was severely disturbed. In the 14 cases % delta LCBF/delta CO2 was below 0%/mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Neurosurgery, Nara Medical University, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kawaguchi
authors.forename: T
authors.initials: T
authors.lastname: Sakaki
authors.forename: K
authors.initials: K
authors.lastname: Kamada
authors.forename: H
authors.initials: H
authors.lastname: Iwanaga
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002245:Carbon Dioxide / Q000097:blood*; D002536:Cerebral Arteries / Q000601:surgery; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013699:Temporal Arteries / Q000601:surgery
chemical_list: D002245:Carbon Dioxide