ABSTRACT
OBJECTIVE: The purpose of this study was to objectively assess the efficacy of superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery using Technetium (Tc)-99m-ethyl cysteinate dimer (ECD) single photon emission computed tomography (SPECT) in patients who underwent STA-MCA bypass surgery. MATERIALS AND METHODS: Brain perfusion SPECT images obtained at baseline and after the administration of acetazolamide were reconstructed using statistical parametric mapping in 23 patients, both before and after STA-MCA bypass surgery. The clinical outcomes of the surgery were also recorded and compared with the hemodynamic changes. A voxel with an uncorrected p-value of less than 0.001 was considered to be statistically significant. RESULTS: SPECT images of the territory supplied by the bypass graft showed an increase in both cerebrovascular flow and reserve at baseline, and the increase was significantly higher following the administration of acetazolamide. All patients showed improvement of clinical symptoms and increased blood flow to the left temporal, parietal, and frontal cortices as well as the thalamus. CONCLUSION: Brain SPECT effectively and objectively demonstrated the improved outcomes of STA-MCA bypass surgery, and thus may be used in postoperative analyses.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Acetazolamide , Brain/diagnostic imaging , Brain Mapping/methods , Carotid Stenosis/surgery , Cerebral Revascularization , Cerebrovascular Circulation , Cysteine/analogs & derivatives , Follow-Up Studies , Image Processing, Computer-Assisted , Intracranial Arteriosclerosis/surgery , Middle Cerebral Artery/surgery , Models, Statistical , Organotechnetium Compounds , Predictive Value of Tests , Radiopharmaceuticals , Temporal Arteries/surgery , Tomography, Emission-Computed, Single-Photon/methods , Treatment OutcomeABSTRACT
Se estudia la evolución alejada de 255 operaciones por estenosis ateroesclerótica de bifurcación carotídea; 185 en 166 pacientes con isquemia cerebral transitoria y 70 en pacientes asintomáticos. Las operaciones realizadas fueron: endarterectomía en 194, endaterectomía y angioplastia en 54 y resección y reemplazo en 7. En todos se usó "shunt" interno. En pacientes con isquemia cerebral transitoria ocurrieron 4 hemiplejías postoperatorias y en el asintomático 1 caso. En la evolución alejada ocurrieron 8 complicaciones de la operación en el grupo de isquemia cerebral transitoria: 2 nuevos episodios, 1 reestenosis, 1 hemorragia cerebral, 1 infección y 3 oclusiones. Ocurrieron 9 episodios neurológicos en otros sectores. La causa de muerte más común fue el infarto del miocardio. En el grupo asintomático ocurrieron 3 oclusiones y 1 hemiplejía