内頚動脈系閉塞性脳血管病変に対するSTA-MCA bypass術後の急性期画像評価

Abstract

Superficial temporal artery-middle cerebral artery (STA-MCA) bypass for steno-occlusive cerebrovascular disease prevents future ischemic stroke by improving cerebral blood flow (CBF). Cerebral ischemia and hyperperfusion are potential complications of this procedure during the early postoperative period. We designed this study to investigate the efficacy of neuroradiological evaluation during early postoperative period after revascularization to detect postoperative pathological conditions of the brain and to avoid these complications. Eight consecutive patients (7 men and 1 woman; mean age 62.6 years) suffering from cerebral ischemia due to occlusive cerebrovascular disease with hemodynamic compromise were enrolled in this study. The underlying pathological condition was internal carotid artery (ICA) or MCA occlusion in 7 cases and MCA severe stenosis in 1 case. The standard STA-MCA bypass was performed for all cases. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) were performed on the day after surgery, and single photon emission computed tomography (SPECT) was performed 1 and 7 days after surgery. Postoperative MRA on Day 1 showed patency of the bypass in all cases. Postoperative MRI on Day 1 revealed no ischemic or hemorrhagic complications in any of the cases. Postoperative SPECT showed transient focal intense increase in CBF around the sites of anastomosis in all 8 cases. Intensive blood pressure control was performed to prevent symptomatic hyperperfusion. All cases were discharged without perioperative complications with an average of 19.8 days of postoperative hospital stay. Neuroradiological evaluation during the early postoperative period enables safe perioperative management by revealing underlying pathological conditions of the brain following revascularization surgery.