Preoperative Guidance and Postoperative Evaluation in Patients with Severe Stenosis ofInternal Carotid Artery before and after Stent Placement using Computer TomographyPerfusion Imaging
WEN Hong-Feng;CHEN Yu;WANG Pei-fu;LI Ji-Lai;DU Ji-Chen;Ren-Yan.
2011, 6(04):
280-286.
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Objective To evaluate the computed tomography perfusion (CTP) imaging with digital subtractionangiography (DSA) in severe carotid artery stenosis before and after stenting and clinical evaluationof hemodynamic changes.Methods Forty cases with DSA examinations showed severe unilateral internal carotid arterystenosis, CTP imaging was made. Twenty cases that DSA examinations showed good compensatoryischemia and blood flow in patients with no obvious delay were not made stents; the other 20 caseswithout a compensatory or compensation inadequate blood flow were made the stent surgery. Therelative perfusion parameters of non-operative group and surgical group (including preoperative,postoperative 1 year) were carried out comparative analysis. To surgical group, absolute perfusionparameters of different periods (including preoperative, postoperative 7 days and after 1 year) werecompared similarly.Results Two groups at the first time examination, relative mean transit time (rMTT), relativecerebral blood flow (rCBF), relative cerebral blood volume (rCBV) were compared, P =(0.471,0.018, 0.015), after 1 year comparison, P =(0.012, 0.132, 0.466); Compared with the contralateral,ipsilateral surgery preoperative baseline mean transit time (MTT) delayed, cerebral blood flow(CBF) reduced, cerebral blood volume (CBV) increased, 7 days after surgery, ipsilateral MTTshortened, CBF increased significantly, CBV reduced, 1 year after surgery, MTT, CBF, CBV ofboth sides were more closed to each other. Even though the two groups were statistically significant(P =0.015, 0.012, 0.037), the general trend of the three variables gradually approached; The changesof absolute perfusion parameters of both sides at different time points including before surgery,7days and 1 year after surgery were significantly (P =0.001, 0.009, 0.028); Between stent and timeinteracted eath other (P =0.006, 0.002, 0.032).Conclusion CTP can help select the surgical indications of severe internal carotid artery stenosis.Carotid artery stenting (CAS) can really improve patients with cerebral blood flow condition.
