Przydatność badania perfuzyjnego TK (p-TK) w ocenie przepływu mózgowego i autoregulacji u pacjentów ze zwężeniem tętnicy szyjnej wewnętrznej przed i po zabiegu operacyjnym lub stentowaniem : doniesienie wstępne

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Background: Improvement of brain perfusion and disappearance o f neurological symptoms are the objective indicators of successful treatment of carotid stenosis. The perfusion CT technique is a component of a comprehensive evaluation o f blood flow in cerebropetal arteries and brain perfusion. Material/Methods: In the period of 2002-2004, perfusion CT exams were performed in 40 symptomatic patients being treated at our Surgery or Radiology Departments because o f one-sided internal carotid stenosis (more than 70%). The exams were performed before and after the surgical procedure (23 patients) or stenting (17 patients). rCBV, rCBF, MTT, and TTP were evaluated. Results: In a subgroup of 16 patients with carotid stenosis (less then 90%), a significant prolongation of MTT and a decrease in rCBF were observed in preoperative perfusion CT. In another subgroup of 24 patients with tight stenosis (more than 90%), changes in perfusion parameters ipsilateral to the stenosis were observed in every patient; MTT prolongation (by 35%) was the most profound change. In 14 patients in the critical stenosis subgroup which presented clinical symptoms (for at least 5 years), exams were performed after acetazolamide (Diamox) provocation to assess vascular autoregulation. The additional parameter of cerebrovascular reserve capacity (CRC) was introduced. In the evaluated group, 5 of the 14 patients presented complications, of which intracranial hemorrhage was the most severe. Mild symptoms of reperfusion syndrome in the subgroup of moderate stenosis occurred in one case only. Analysis of preoperative perfusion parameters revealed statistically significant increases in CBV and CBF as well as shortening of MTT and TTP ipsilaterally to the carotid stenosis. Conclusions: Perfusion CT is of significant importance in the evaluation of the effectiveness of procedures to restore carotid patency. Perfusion evaluation by means of autoregulation test (test with acetazolamide) enables prognosis of the course of the postoperative period in patients at risk of reperfusion syndrome,