Hemodynamic evaluation before and after the STA-MCA anastomosis--with special reference to measurement of regional transit time with intra-arterial digital subtraction angiography.
Twenty-seven patients with minor completed and major stroke in the chronic stage underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. The regional cerebral blood flow (rCBF), using inhalation of stable xenon and computed tomographic scanning (Xes CT-CBF study), and the mode of transit time (MTT) in the MCA territory using intra-arterial digital aortography were measured. Activated rCBF and MTT was measured 20 minutes after the administration of acetazolamide (10 mg/kg) in 14 patients. Nineteen of the 23 patients with minor stroke (Group 1) showed immediate improvement in their neurological state within a few days of the operation, while four patients with minor stroke (Group 2) and four patients with major stroke (Group 3) showed no improvement. Based on the rCBF obtained with the Xes CT-CBF study, affected side rCBF/unaffected side rCBF and %f [(peak DSA number/affected side MTT)/(peak DSA number/unaffected side MTT)] were compared. There was a significant positive correlation. Affected side MTT in Group 1 was 6.41 +/- 1.16 sec, preoperatively, and significantly decreased to 5.13 +/- 0.91 sec after the operation. On the other hand, preoperative MTT in Group 2 was 4.40 +/- 0.81 sec and 4.76 +/- 0.89 sec, postoperatively. Preoperative %f in Group 1 was 0.514 +/- 0.143 and significantly increased to 0.739 +/- 0.154, postoperatively. Group 2 showed no change. Vasodilatory capacity with acetazolamide showed a marked improvement in Group 1, postoperatively. Our study indicated that if MTT is moderately lengthened, %f is moderately decreased, and vasodilatory capacity is impaired, in patients with minor ischemic stroke will benefit from STA-MCA anastomosis.
Touho
H
H
Department of Neurosurgery, Osaka Neurological Institute.
Karasawa
J
J
Shishido
H
H
Yamada
K
K
Shibamoto
K
K
D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D006439:Hemodynamics; D006801:Humans; D011184:Postoperative Period; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014978:Xenon
D014978:Xenon