Evaluation of cerebral hemodynamic changes before interventional angioplasty in the patients with severe cervicocerebral arterial stenosis using CT perfusion
Hua-wei Ling,Bei Ding,Ke-min Chen
Department of Radiology,Ruijin Hospital,School of Medicine,Shanghai Jiaotong University. Shanghai 200025, China
Abstract Purpose:The purpose of this study was to evaluate the role of CT perfusion in monitoring hemodynamic status in the patients with severe cervico-cerebral arterial stenosis and explore it’s potential significance in guiding interventional angioplasty. Methods:A consecutive series of 22 patients (12 male, 10 female), diagnosed by DSA as an arterial stenosis (13 internal carotid stenosis, 7 vertebrobasilar stenosis and 2 middle cerebral artery) was included in this prospective study. Mean age was 56.3 (range 27-79y, SD 17.2). CT perfusion was performed before primary stent placement using 16-slice GE lightspeed scanner during the injection of 50 mL of contrast material. Perfusion coverage was adjusted according to vascular territory of interest. Mean cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) were calculated for different vascular territories in each hemisphere. Results:4 patients demonstrated normal brain perfusion. 18 patients had a baseline perfusion abnormality. Using Kruskal-Wallis U test, significantly longer MTT and varied degree of CBF and CBV decline (P<0.05) was observed in the symptomatic artery territory before surgery intervention. Conclusion:CT perfusion could be an interesting new method to evaluate patients before stenting, giving in particular information about hemodynamic changes which could be helpful in clinical treatment planning.
Key words:Cervicocerebral artery, Stenosis, Perfusion imaging, Tomography
颅颈部动脉狭窄是引发缺血性脑血管病的常见病因,患者的卒中发生率高且有较高的死亡率和不同程度的致残率,内科保守治疗效果欠佳,严重威胁人类生命健康。近年来,随着神经介入技术的快速发展,血管内支架在柔顺性、支撑力、输送系统方面的改进,采用血管支架成形术治疗颅脑血管疾病被证实是一种有效且相对安全的方法[1]。然而,对准备行颅内血管内架成形术的患者需进行严格、细致的术前评估,选择适合的病例以提高手术成功率、减少手术并发症,其中脑血流动力学的状态是一个重要的相关因素。本文收集一组计划行支架成形术的颅颈部动脉重度狭窄患者,进行CT脑部灌注成像检查,分析其血流灌注特点。
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