Tomographic cerebral blood flow measurement during carotid surgery.
OBJECTIVE
The aim of the study was to depict regional cerebral blood flow (rCBF) during carotid cross clamping using 99mTechnetium-hexamethylpropylene amine oxime (TcHMPAO). This tracer rapidly passes the blood-brain barrier and is retained for hours in the brain tissue. Injecting TcHMPAO during surgery and performing single photon emission computer tomography (SPECT) scanning shortly after the operation thereby pictures rCBF at the time of injection.


METHODS
Ongoing prospective study.


METHODS
Departments of Vascular Surgery, Neurology and Anaesthesiology, University Hospital, Rigshospitalet, Copenhagen, Denmark.


METHODS
15 patients who during a period of 4 months underwent carotid endarterectomy.


METHODS
Prior to surgery rCBF was determined using 133Xe and SPECT. Intraoperatively stump pressure was measured and a bolus of TcHMPAO was injected for later SPECT measurement.


RESULTS
We found a significant correlation between stump pressure and enhancement of side-to-side asymmetry in rCBF due to carotid cross clamping. Pronounced variations were seen in which regions were deprived of perfusion during clamping.


CONCLUSIONS
TcHMPAO allows tomographic assessment of CBF during carotid surgery. This method may serve as a reference tool in future research on intraoperative cerebral haemodynamics.
Knudsen
L
L
Department of Vascular Surgery, University Hospital, Rigshospitalet, Copenhagen, Denmark.
Vorstrup
S
S
Olsen
K S
KS
Videbaek
C
C
Schroeder
T V
TV
D000368:Aged; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010091:Oximes; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime