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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Evaluation of hemodynamic changes after extracranial-intracranial bypass using dynamic perfusion CT imaging with acetazolamide challenge

Meeting Abstract

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  • Angelo Tortora - Department of Neurosurgery, Heinrich-Heine-Universität, Düsseldorf, Deutschland
  • Hosai Sadat - Department of Neurosurgery, Heinrich-Heine-Universität, Düsseldorf, Deutschland
  • Hans-Jakob Steiger - Universitätsklinikum Düsseldorf, Neurochirurgische Klinik, Düsseldorf, Deutschland
  • Bernd Turowski - Division of Neuroradiology, Institute of Radiology, Heinrich-Heine-Universität, Düsseldorf, Deutschland
  • Jan F. Cornelius - Department of Neurosurgery, Heinrich-Heine-Universität, Düsseldorf, Deutschland
  • Athanasios Petridis - Department of Neurosurgery, Heinrich-Heine-Universität, Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.12.09

doi: 10.3205/17dgnc445, urn:nbn:de:0183-17dgnc4453

Published: June 9, 2017

© 2017 Tortora et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Since the failure of the extracranial-intracranial (EC-IC) bypass study and COSS study in showing the usefulness of cerebral revascularization to decrease stroke risk in patients with chronic cerebrovascular insufficiency great effort was made to identify a subgroup of high-risk patients who might benefit of bypass surgery. CT perfusion (CTP) imaging with Acetazolamide (ACZ) challenge gained an increasing role in detecting patients with impaired autoregulatory reserves. Little is known about hemodynamic changes in CTP imaging before and after surgery, in particular if impaired cerebral reactivity improves after revascularization.

Methods: 33 patients undergoing 37 EC-IC bypasses were studied with CTP including ACZ challenge before and on average 3 months after surgery. 22 patients were treated for moyamoya disease, 13 for carotid occlusion and 2 for stenosis of the middle cerebral artery. Cerebral blood flow (CBF), mean transit time (MTT) time-to-maximum (Tmax) were assessed in the affected hemispheres before and after ACZ and a CBF reactivity index (RI) was calculated for the ACZ challenge.

Results: Baseline Tmax and ACZ Tmax in the affected hemisphere decreased after surgery by 4.5 and 7.5 arbitrary units (approximately corresponding to deci-seconds). The postoperative reduction of Tmax after ACZ challenge was statistically highly significant (p=0.003). Baseline CBF improved by 5.6 arbitrary units (corresponding approximately to ml/100g tissue) and ACZ CBF improved by 5.2 units. Baseline MTT and ACZ MTT were unchanged after surgery, as well as the RI.

Conclusion: EC-IC bypass resulted in a reduction of Tmax values and improvement of CBF. These parameters should be used for the CTP assessment of bypass function. Our study did not confirm improvement of ACZ CBF reactivity by EC-IC bypass.