title: Progressive Cortical Neuronal Damage and Extracranial-Intracranial Bypass Surgery in Patients with Misery Perfusion.
abstract: OBJECTIVE
  Misery perfusion may cause selective neuronal damage in atherosclerotic ICA or MCA disease. Bypass surgery can improve misery perfusion and may prevent neuronal damage. On the other hand, surgery conveys a risk for neuronal damage. The purpose of this retrospective study was to determine whether progression of cortical neuronal damage in surgically treated patients with misery perfusion is larger than that in surgically treated patients without misery perfusion or medically treated patients with misery perfusion.
  
  
  METHODS
  We evaluated the distribution of benzodiazepine receptors twice by using PET and11C-labeled flumazenil in 18 surgically treated patients with atherosclerotic ICA or MCA disease (9 with misery perfusion and 9 without) and no perioperative stroke before and after bypass surgery; in 8 medically treated patients with misery perfusion and no intervening ischemic event; and in 7 healthy controls. We quantified abnormal decreases in the benzodiazepine receptors of the cerebral cortex within the MCA distribution and compared changes in the benzodiazepine receptor index among the 3 groups.
  
  
  RESULTS
  The change in the benzodiazepine receptor index in surgically treated patients with misery perfusion (27.5 ± 15.6) during 7 ± 5 months was significantly larger than that in surgically treated patients without misery perfusion (-5.2 ± 9.4) during 6 ± 4 months (P< .001) and in medically treated patients with misery perfusion (3.2 ± 15.4) during 16 ± 6 months (P< .01).
  
  
  CONCLUSIONS
  Progression of cortical neuronal damage in surgically treated patients with misery perfusion and no perioperative stroke may occur and may be larger than that in medically treated patients with misery perfusion and no intervening ischemic event.
authors.affiliation: From the Division of PET Imaging (H.Y., S.K., Y.K., M.T., T.H.), Shiga Medical Center Research Institute, Moriyama, Japan yamauchi@res.med.shiga-pref.jp.
authors.forename: H
authors.identifier: http://orcid.org/0000-0001-9020-4143
authors.initials: H
authors.lastname: Yamauchi
authors.affiliation: From the Division of PET Imaging (H.Y., S.K., Y.K., M.T., T.H.), Shiga Medical Center Research Institute, Moriyama, Japan.
authors.forename: S
authors.identifier: http://orcid.org/0000-0001-5514-929X
authors.initials: S
authors.lastname: Kagawa
authors.affiliation: From the Division of PET Imaging (H.Y., S.K., Y.K., M.T., T.H.), Shiga Medical Center Research Institute, Moriyama, Japan.
authors.forename: Y
authors.identifier: http://orcid.org/0000-0002-3106-0255
authors.initials: Y
authors.lastname: Kishibe
authors.affiliation: From the Division of PET Imaging (H.Y., S.K., Y.K., M.T., T.H.), Shiga Medical Center Research Institute, Moriyama, Japan.
authors.forename: M
authors.identifier: http://orcid.org/0000-0001-6789-8175
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: From the Division of PET Imaging (H.Y., S.K., Y.K., M.T., T.H.), Shiga Medical Center Research Institute, Moriyama, Japan.|National Institute of Radiological Sciences (T.H.), National Institutes of Quantum and Radiological Science and Technology, Chiba, Japan.
authors.forename: T
authors.identifier: http://orcid.org/0000-0002-8338-4737
authors.initials: T
authors.lastname: Higashi
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000601:surgery*; D002540:Cerebral Cortex / Q000098:blood supply* / Q000378:metabolism / Q000473:pathology*; D002548:Cerebral Revascularization / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011963:Receptors, GABA-A / Q000032:analysis* / Q000378:metabolism; D012189:Retrospective Studies
chemical_list: D011963:Receptors, GABA-A