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Intraoperative Perfusion Computed Tomography in Carotid Endarterectomy: Initial Experience in 16 Cases

View Article: PubMed Central - PubMed

ABSTRACT

Background: This study aimed to evaluate the changes in perfusion computed tomography (PCT) parameters in carotid endarterectomy (CEA), and to discuss the use of intraoperative PCT in CEA.

Material/methods: Sixteen patients with carotid stenosis who also underwent CEA with intraoperative CT were recruited in this study. We calculated quantitative data on cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and the relative parameter values, including relative CBF (rCBF), relative CBV (rCBV), and relative TTP (rTTP). The role of PCT was assessed and compared to conventional monitoring methods.

Results: There were no significant differences in any of the parameters in the anterior cerebral artery (ACA) territory (P>0.05). In the middle cerebral artery (MCA) territory, the CBF and CBV increased and TTP decreased in the operated side during CEA; the rCBF and rCBV increased and the rTTP decreased significantly (P<0.05). In 16 patients, CT parameters were improved, SSEP was normal, and MDU was abnormal. In 3 patients, CBF increased by more than 70% during CEA. Relative PCT parameters are sensitive indicators for detecting early cerebral hemodynamic changes during CEA. Cerebral hemodynamics changed significantly in the MCA territory during CEA.

Conclusions: Intraoperative PCT could be an important adjuvant monitoring method in CEA.

No MeSH data available.


Related in: MedlinePlus

Preoperative DSA revealing a 90% stenosis of the left internal carotid artery (A). PCT before CEA demonstrates a slightly decreased CBF (B), decreased CBV (C), and increased TTP (D) in the left hemisphere. Intraoperative SSEP in the left side indicated no changes (E). During CEA, PCT demonstrated increased CBF (F) and CBV (G), and decreased TTP (H). Compared relative PCT parameters before and during CEA. The rCBF increased from 0.78 to 1.23, the rCBV increased from 0.84 to 1.16, and the rTTP decreased from 1.25 to 0.90. CBF – cerebral blood flow; CBV – cerebral blood volume; CEA – carotid endarterectomy; DSA – digital subtraction angiography; PCT – perfusion computed tomography; rCBF – relative CBF rCBV – relative CBV; rTTP – relative TTP; TTP – time to peak.
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f1-medscimonit-22-3362: Preoperative DSA revealing a 90% stenosis of the left internal carotid artery (A). PCT before CEA demonstrates a slightly decreased CBF (B), decreased CBV (C), and increased TTP (D) in the left hemisphere. Intraoperative SSEP in the left side indicated no changes (E). During CEA, PCT demonstrated increased CBF (F) and CBV (G), and decreased TTP (H). Compared relative PCT parameters before and during CEA. The rCBF increased from 0.78 to 1.23, the rCBV increased from 0.84 to 1.16, and the rTTP decreased from 1.25 to 0.90. CBF – cerebral blood flow; CBV – cerebral blood volume; CEA – carotid endarterectomy; DSA – digital subtraction angiography; PCT – perfusion computed tomography; rCBF – relative CBF rCBV – relative CBV; rTTP – relative TTP; TTP – time to peak.

Mentions: In all 16 patients, PCT parameters were improved, SSEP was normal, and MDU was abnormal. In 3 patients, CBF increased by more than 70% after CEA (Figure 1).


Intraoperative Perfusion Computed Tomography in Carotid Endarterectomy: Initial Experience in 16 Cases
Preoperative DSA revealing a 90% stenosis of the left internal carotid artery (A). PCT before CEA demonstrates a slightly decreased CBF (B), decreased CBV (C), and increased TTP (D) in the left hemisphere. Intraoperative SSEP in the left side indicated no changes (E). During CEA, PCT demonstrated increased CBF (F) and CBV (G), and decreased TTP (H). Compared relative PCT parameters before and during CEA. The rCBF increased from 0.78 to 1.23, the rCBV increased from 0.84 to 1.16, and the rTTP decreased from 1.25 to 0.90. CBF – cerebral blood flow; CBV – cerebral blood volume; CEA – carotid endarterectomy; DSA – digital subtraction angiography; PCT – perfusion computed tomography; rCBF – relative CBF rCBV – relative CBV; rTTP – relative TTP; TTP – time to peak.
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Related In: Results  -  Collection

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f1-medscimonit-22-3362: Preoperative DSA revealing a 90% stenosis of the left internal carotid artery (A). PCT before CEA demonstrates a slightly decreased CBF (B), decreased CBV (C), and increased TTP (D) in the left hemisphere. Intraoperative SSEP in the left side indicated no changes (E). During CEA, PCT demonstrated increased CBF (F) and CBV (G), and decreased TTP (H). Compared relative PCT parameters before and during CEA. The rCBF increased from 0.78 to 1.23, the rCBV increased from 0.84 to 1.16, and the rTTP decreased from 1.25 to 0.90. CBF – cerebral blood flow; CBV – cerebral blood volume; CEA – carotid endarterectomy; DSA – digital subtraction angiography; PCT – perfusion computed tomography; rCBF – relative CBF rCBV – relative CBV; rTTP – relative TTP; TTP – time to peak.
Mentions: In all 16 patients, PCT parameters were improved, SSEP was normal, and MDU was abnormal. In 3 patients, CBF increased by more than 70% after CEA (Figure 1).

View Article: PubMed Central - PubMed

ABSTRACT

Background: This study aimed to evaluate the changes in perfusion computed tomography (PCT) parameters in carotid endarterectomy (CEA), and to discuss the use of intraoperative PCT in CEA.

Material/methods: Sixteen patients with carotid stenosis who also underwent CEA with intraoperative CT were recruited in this study. We calculated quantitative data on cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and the relative parameter values, including relative CBF (rCBF), relative CBV (rCBV), and relative TTP (rTTP). The role of PCT was assessed and compared to conventional monitoring methods.

Results: There were no significant differences in any of the parameters in the anterior cerebral artery (ACA) territory (P>0.05). In the middle cerebral artery (MCA) territory, the CBF and CBV increased and TTP decreased in the operated side during CEA; the rCBF and rCBV increased and the rTTP decreased significantly (P<0.05). In 16 patients, CT parameters were improved, SSEP was normal, and MDU was abnormal. In 3 patients, CBF increased by more than 70% during CEA. Relative PCT parameters are sensitive indicators for detecting early cerebral hemodynamic changes during CEA. Cerebral hemodynamics changed significantly in the MCA territory during CEA.

Conclusions: Intraoperative PCT could be an important adjuvant monitoring method in CEA.

No MeSH data available.


Related in: MedlinePlus