<SUP>133</SUP>Xe SPECTによる定量的評価に基づいた慢性期内頸動脈系閉塞性病変に対するバイパス術の効果

Abstract

To evaluate the efficacy of bypass surgery, we analyzed the clinical outcome and cerebral hemodynamics of patients treated with bypass surgery.Over a 3-year period, 21 patients were defined by clinical and laboratory criteria as suffering from hemodynamic cerebral ischemia. All patients had one or more episodes of focal cerebral ischemia due to unilateral internal carotid or middle cerebral artery occlusion. Computerized tomography scans either were normal or showed evidence of watershed infarction. The baseline cerebral blood flow (CBF) and cerebral vasodilatory capacity (CVC) were studied using 133Xe single-photon emission CT and acetazolamide test, and both were found to be significantly reduced in all patients. Based on these criteria, superficial temporal artery-middle cerebral artery anastomosis was performed. One patient suffered a postoperative stroke with complete recovery, resulting in a morbidity rate of 4.8%. Over a mean follow-up period of 20 months, no patient had another episode of cerebral ischemia. Follow-up studies of baseline CBF and CVC showed significant improvement of the latter while the former was essentially unchanged. In view of these findings, we conclude that bypass surgery constitutes appropriate therapy for patients with hemodynamic cerebral ischemia, defined using the strict selection criteria employed in this study.