Carotid endarterectomy. Pre- and post-operative monitoring with cerebral SPECT.
In the pre-operative evaluation of carotid endarterectomy, the knowledge of ischemic areas may be helpful to reduce the operative risk. A positive CT scan is often correlated with an increased operative risk. The single photon emission computed tomography (SPECT) allows us to visualize ischemic areas not shown by the CT; these areas are almost always correlated to neurological symptomatology. In patients with positive CT scan, the ischemic areas shown by SPECT are generally larger, because this technique visualize the ischemic area surrounding the cerebral infarct (penumbra). After carotid EA, SPECT is useful to show the hemodynamic modifications induced by this operation. In a series of 15 patients we observed an improvement of the cerebral blood perfusion characterized by the normalization of the blood flow in 7/12 (58%) of the ischemic areas observed pre-operatively), an improvement in 3/12 and a normalization or an improvement in the contralateral hemisphere in 5/7 of the areas. In conclusion SPECT is a useful technique to study the cerebral pathophysiology of both cerebrovascular disease and its surgical treatment.
D'Addato
M
M
Chair of Vascular Surgery, University of Bologna, Italy.
Pedrini
L
L
Stella
A
A
Pecchi
M
M
Monetti
N
N
Dondi
M
M
Daidone
R
R
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D004691:Endarterectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011182:Postoperative Care; D011300:Preoperative Care; D014055:Tomography, Emission-Computed