Related Study In Evaluating Intracranial Hemodynamics Of Patients With Carotid Artery Stenosis By Using Perfusion Computed Tomography

Purpose:To investigate the character of intracranial hemodynamic characters of carotid arteriosclerotic patients,to conclude the effect of cerebral perfusion CT in preoperative and postoperative evaluation and prognosis,and to analysis the influence of different embolic protection devices to patients' cerebral perfusion.Methods:We retrospectively collected and analyzed the image information of digital subtraction angiography(DSA) and perioperative cerebral perfusion CT(PCT) of suspected carotid arteriosclerotic patients during June 2008 to January 2009 in Huashan Hospital.All the patients accepted DSA,and Perfusion CT before the Angiography;the patients treated with carotid arterioplasty accepted PCT again three days after treatment.We divided patients into three groups according to the DSA results:GroupⅠ:mild or without stenosis(＜50%),GroupⅡ:moderate stenosis(50%～70%),GroupⅢ:severe stenosis or occlusion(＞70%).We analyzed the association between the perfusion parameter value and the grade of carotid artery stenosis,and calculate the changes of perfusion parameter value brought by carotid arterioplasty.Results:During June 2008 to January 2009,46 suspected carotid arteriosclerotic patients had accepted DSA.It's proved that there were 52 carotid arteries with mild or without stenosis(56.5%),18 carotid arteries with moderate stenosis(19.6%),22 carotid arteries with severe stenosis(23.9%).The mean parameter values of each group were as follows: GroupⅠ,CBF:51.4±6.8 ml/100g/min,CBV:3.30±0.7 ml/100g,MTT:3.8±1.1s;GroupⅡ,CBF:49.4±5.2 ml/100g/min,CBV:3.55±0.6 ml/100g, MTT:5.9±1.5 s,GroupⅢ,CBF:47.9±9.5 ml/100g/min,CBV:3.64±0.8 ml/100g,MTT:6.9±1.8 s.Using Student's t-test,the CBF and CBV values in GroupⅡand GroupⅢwere not significantly different in comparison with those in GroupⅠ(P＞0.05),while the MTT values in GroupⅡand GroupⅢwere both significantly different in comparison with those in GroupⅠ. (P＜0.05).38 patients accepted carotid arterioplasty,including 3 carotid endarterectomy,34 carotid stenting,1 carotid angioplasty with cutting ballon.The ipsolateral mean parameter values were as follows: preoperative CBF:48.9±4.3 ml/100g/min,CBV:3.71±0.5 ml/100g,MTT:6.2±1.4s;postoperative CBF:50.5±4.8 ml/100g/min,CBV:3.45±0.6 ml/100g, MTT:4.3±1.6s.Using paired t-test,there were no significant differences between preoperative CBF/CBV and postoperative CBF/CBV, while postoperative MTT was significantly decorated in comparison with preoperative one.Conclusions:1.We could evaluate carotid arteriosclerotic patients' cerebral hemodynamic characters with perfusion CT,with an appearance of unchanged or mild increased CBF and significantly prolonged MTT.These changes became more significant as the degree of carotid artery stenosis increased;2.We could use perfusion CT to evaluate the surgery treatment of carotid arteriosclerosis,with an appearance of significantly decreased MTT;3.We couldn't predict postoperative hyperfusion syndrome only with preoperative perfusion CT;4.There's no significant differences between the patients' cerebral perfusion with different embolic protection devices.