閉塞性脳血管障害患者に対する血行再建術前後の頚動脈超音波，ＳＰＥＣＴ，高次脳機能所見

Abstract

We examined the usefulness of ultrasonography, single photon emission computed tomography (SPECT) and neuropsychological function assessment pre- and postoperatively in 14 patients with occlusive cerebrovascular disease who underwent surgical revascularization. Two groups were analyzed: patients who underwent carotid endarterectomy (CEA; n=7) and extracranial-intracranial (EC-IC) bypass (n=7) . The mean flow velocity (MFV) and pulsatility index (PI) of the common carotid artery (CCA), internal carotid artery (ICA) and external carotid artery (ECA) were determined by spectral pulsed Doppler ultrasonography. The cerebral blood flow (CBF) in the affected frontal lobe under resting conditions and after acetazolamide loading was evaluated using SPECT. Neuropsychological function was assessed by carrying out the kana pick-up test, revised Hasegawa dementia scale (HDS-R) and mini-mental state examination (MMS) . In the CEA group, the proximal PI of the CCA was lower and the distal PI of the ICA was higher postoperatively than preoperatively. In the EC-IC bypass group, the PI values of the CCA and ECA were lower postoperatively than preoperatively. These findings showed hemodynamic improvement of the surgically revascularized carotid arteries. Twelve of the 14 patients showed postoperative improvements in their kana pick-up test scores and the CBF evaluated by SPECT. In conclusion, surgical revascularization improves hemodynamic insufficiency and neuropsychological function in patients with occlusive cerebrovascular disease. Follow-up study using ultrasonography is useful for evaluating hemodynamic changes in patients with cerebrovascular disease.