Intraoperative middle cerebral artery pressure measurements during superficial temporal artery to middle cerebral artery bypass procedures in patients with cerebral atherosclerotic disease

Autor: Hiroyasu Kamiyama, Fumihiro Matano, Akira Teramoto, Kojiro Tateyama, Sunao Mizumura, Shiro Kobayashi, Yasuo Murai, Rokuya Tanikawa, Akio Morita, Takayuki Mizunari, Tomonori Tamaki
Rok vydání: 2016
Předmět:
Adult
Male
Middle Cerebral Artery
medicine.medical_specialty
Intraoperative Neurophysiological Monitoring
medicine.medical_treatment
Hemodynamics
Blood Pressure
030204 cardiovascular system & hematology
Revascularization
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Risk Factors
Internal medicine
medicine.artery
medicine
Humans
cardiovascular diseases
Radial artery
Cerebral perfusion pressure
Aged
Retrospective Studies
Aged
80 and over
Tomography
Emission-Computed
Single-Photon
Cerebral Revascularization
business.industry
General Medicine
Middle Aged
Intracranial Arteriosclerosis
Superficial temporal artery
Temporal Arteries
Cerebral blood flow
Anesthesia
Middle cerebral artery
cardiovascular system
Cardiology
Arterial line
Female
business
030217 neurology & neurosurgery
circulatory and respiratory physiology
Zdroj: Journal of Neurosurgery. 125:1367-1373
ISSN: 1933-0693
0022-3085
Popis: OBJECTIVE No previous study has monitored middle cerebral artery (MCA) pressure during the superficial temporal artery (STA)-MCA bypass procedure for cerebral atherosclerotic disease. In this paper, the authors describe their method of monitoring MCA pressure and report their initial data on intraoperative MCA pressure and its relationship with hemodynamics prior to and after the bypass procedures. METHODS The results from a total of 39 revascularization procedures performed between 2004 and 2014 were analyzed. The patient group included 27 men and 12 women, and their mean age at surgery was 67.6 years (range 39–83 years). The authors investigated the MCA pressure via the STA during STA-MCA bypass procedures. After one branch of the STA was anastomosed to the MCA, the other branch was connected to an arterial line, and a clip was placed temporally on the main STA trunk to monitor the pre-anastomosis MCA pressure. Simultaneously, the radial artery (RA) pressure was determined before removing the temporal clip to measure the post-anastomosis MCA pressure. The relationship between MCA pressures and single photon emission computed tomography findings and the risk factors for hyperperfusion after STA-MCA bypass were analyzed. RESULTS The MCA/RA (%) pressure was significantly correlated with that of the resting stenotic/normal side cerebral blood flow (CBF) ratio (%) in the linear regression analysis (slope 1.200, r2 = 0.3564, F = 20.49, p < 0.0001). The intraoperative MCA pressure was 39.3% of RA pressure in patients with Powers' Stage 2 cerebral atherosclerotic disease. After 1 branch of the STA was anastomosed, the intraoperative MCA pressure increased to 75.3% of the RA pressure. The rate of increase in pressure was significantly correlated with the increase in the STA diameter in the linear regression analysis (slope 2.59, r2 = 0.205, F = 9.549, p = 0.0038). Hyperperfusion occurred in 2 cases. When mean values for these 2 patients were compared with those for the 37 patients without hyperperfusion, significant differences were found in the stenotic/normal side CBF ratio (p = 0.0001), pre-anastomosis MCA pressure (p = 0.02), rate of increase in pressure (p = 0.02), pre-anastomotic MCA/RA pressure ratio (p = 0.01), vascular reserve (p = 0.0489), and STA diameter (p = 0.0002). CONCLUSIONS The measurement of intraoperative MCA pressure may be a useful technique to assess cerebral perfusion and for predicting the risk of hyperperfusion. Monitoring MCA pressure is recommended during STA-MCA bypass procedures for atherosclerotic disease.
Databáze: OpenAIRE
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