Abstract

BACKGROUND

The hemodynamic changes after superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery are unclear.

OBJECTIVE

To clarify the hemodynamics by comparing flow parameters obtained by 4-dimensional (4D) flow magnetic resonance imaging (MRI) and intraoperative MCA pressure measurement.

METHODS

We recruited 23 patients who underwent STA-MCA bypass surgery for internal carotid artery (ICA) or MCA stenosis. We monitored intraoperative MCA, STA, and radial artery (RA) pressure. All patients underwent 4D flow MRI preoperatively and 3 wk after surgery to quantify the blood flow volume (BFV) of the ipsilateral ICA (BFV_iICA), contralateral ICA (BFV_cICA), basilar artery (BFV_BA), ipsilateral STA (BFV_iSTA), and contralateral STA (BFV_cSTA). The sum of intracranial BFV was defined as BFV_total. We compared BFV parameters and intraoperative pressure.

RESULTS

BFV_iSTA significantly increased after surgery (P < .001). BFV_iICA and BFV_BA significantly decreased after surgery (BFV_iICAP = .005; BFV_BAP = .02). No significant difference was observed between BFV_cICA before and after surgery. As a result, BFV_total postoperatively increased by 6.8%; however, no significant difference was observed. Flow direction at M1 changed from antegrade to unclear after surgery in 5 patients. Intraoperative MCA pressure and MCA/RA pressure ratio significantly increased after surgery (P < .001). We found a stronger positive correlation between MCA pressure increase ratio and BFV_total increase ratio in patients with lower pre-MCA pressure (r = 0.907, P < .001).

CONCLUSION

The visual and quantitative assessment of 4D flow MRI revealed that intracranial blood flow changes complementarily after STA-MCA bypass surgery. 4D flow MRI may detect the improvement of cerebral perfusion pressure.

中文翻译：

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颞浅动脉-中脑动脉搭桥术前后4维血流磁共振成像与术中脑中动脉压力测量的交叉比较

摘要

背景

颞浅动脉 (STA) 到大脑中动脉 (MCA) 搭桥手术后的血流动力学变化尚不清楚。

客观的

通过比较 4 维 (4D) 流动磁共振成像 (MRI) 和术中 MCA 压力测量获得的流动参数来阐明血流动力学。

方法

我们招募了 23 名因颈内动脉 (ICA) 或 MCA 狭窄而接受 STA-MCA 搭桥手术的患者。我们监测了术中 MCA、STA 和桡动脉 (RA) 压力。所有患者术前和术后 3 wk 均行 4D 流动 MRI 量化同侧 ICA（BFV _iICA）、对侧 ICA（BFV _cICA）、基底动脉（BFV _BA）、同侧 STA（BFV _iSTA）的血流量（BFV ）和对侧 STA (BFV _cSTA )。颅内BFV的总和定义为BFV_总和。我们比较了 BFV 参数和术中压力。

结果

手术后BFV _iSTA显着增加 ( P  < .001)。手术后BFV _iICA和 BFV _BA显着降低（BFV _iICA P  = .005；BFV _BA P  = .02）。BFV _cICA术前和术后无显着差异。结果，术后BFV_总量增加了 6.8%；然而，没有观察到显着差异。5 例患者术后 M1 流向由顺行变为不清楚。术中 MCA 压力和 MCA/RA 压力比在手术后显着升高（P < .001）。我们发现，在 MCA 前压力较低的患者中，MCA 压力增加率与 BFV_总增加率之间存在更强的正相关（r = 0.907，P  < .001）。

结论

4D 血流 MRI 的视觉和定量评估显示，STA-MCA 搭桥手术后颅内血流发生互补变化。4D 流动 MRI 可以检测脑灌注压的改善。