혈역학적 뇌허혈환자에서 우회로 수술에 의한 혈류예비능력 향상에 대한 연구
Improvement of Cerebrovascular Reserve Capacity by Bypass Surgery in Patients with Hemodynamic Cerebral Ischemia
소속 상세정보
나형균
이경진/조경근/박성찬/박해관/조정기/지철/손형선/강준기
KMID : 0359819990280010035
Abstract
결론
저자들은 14례의 혈역학적 뇌허혈환자에서 우회로 수술을 시행하였으며, 그 결과를 분석
하여 다음과 같은 결론을 얻었다.
우회로 수술환자 선택에 신중을 기해야하리라 생각한다. 저자들의 수술적응기준은 먼저
뇌허혈발작의 병력이 있는 환자에서 뇌혈관 촬영상 뇌혈관의 완전 폐쇄나 80%이상 협착이
있는 환자를 일차대상으로 한다. 이들 환자에서 안정시 및 Acetazolamide투여후의 뇌혈류량
을 측정하여 안정시 뇌혈류량이 병변부위가 반대편보다 10%이상 감소되어있으며(AI<0.9),
Acetazolamide투여후의 AI가 투여전보다 10％이상 감소를 보인예를 대상으로 하였으며, 이
들 기준에 의한 수술결과 12례(95.7%)에서 혈류예비능력의 상승을 볼 수 있었다.
#초록#
To study the effect of extracranial-intracranial(EC/IC) bypass on symptomatic patients
with hemodynamic cerebral ischemia, we prospectively reviewed 14 patients who
underwent EC/IC bypass surgery. A series of 14 patients treated in a 2 years period
met the following criteria, 1) symptomatic internal carotid artery(ICA) or middle cerebral
aetery(MCA) obstruction or stenosis over 80％, 2) decrease in basal cerebral blood
flow(CBF) over 10％, 3) hyporeactivity to acetazolimide of CBF. Among these, the type
of ischemic episode was transient ischemic attack(TIA) or reversible ischemic
neurological deficit(RIND) in 4, minor stroke in 8, and major stroke in 2. Of these, 10
patients had multiple episode of ischemic attack. CT or MRI were showed infarction of
the MCA territory in 3, border zone infarction in 5, basal ganglia infarction in 2 and
multiple lacunar infarction in 4. Based on our criteria, superficial temporal
artery(STA)-MCA anastomosis was performed in 13 cases and EC-IC bypass grafting
using radial artery in one. Average follow up period was 24 months. Postoperative
course was uneventful in 12 patients. One patient suffered a postoperative stroke with
complete recovery and another suffered operative would infection. Of the 14 patients,
12(85.7％) have had an excellent to good outcome with complete resolution or significant
improvement of preoperative neurologic symptom, remaining two show no improvement
of preoperative neurologic deficit. Bypass patency was confirmed by postoperative
angiography in all cases except for one. Postoperative follow up studies of the basal
CBF and response to the acetazolamide of the CBF showed significant increased CBF
activity to acetazolamide in 12 cases(85.7％) while the basal CBF was essentially
unchanged in all cases except for two. In view of these finding, the authors suggest
that EC-IC bypass surgery to be considered as an appropritate therapy for improvement
of the cerebrovascular reserve capacity in patients with hemodynamic cerebral ischemia,
defined using the strict selection criteria employed in this study.
Extracranial-Intracranial bypass surgery; Occlusive vascular disease; Cerebral blood flow; Hemodynamic cerebral ischemia; Acetazolamide; Cerebrovascular reserve capacity;
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