Hemodynamic study of superficial temporal artery-middle cerebral artery bypass in treatment of severe internal carotid artery or middle cerebral artery stenosis

Abstract

Objective To explore the value of dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) in superficial temporal artery-middle cerebral artery (STA-MCA) bypass and to provide radiological evidence for hemodynamic changes in STA-MCA bypass in the treatment of severe internal carotid artery (ICA) and MCA stenosis and/or occlusion.  Methods A total of 76 cases (65 males and 11 females with average age of 55) who underwent STA-MCA bypass from January 2011 to February 2016 were included. Routine MRI and DSC-PWI were performed within one month before operation and within one week after operation. Hemodynamic changes [relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), relative mean transit time (rMTT) and relative time to peak (rTTP)] of MCA blood supplying area at basal ganglia section (proximal end) and centrum semiovale section (distal end) were compared before and after operation.  Results Compared with before operation, rCBF was significantly increased after operation at ipsilateral basal ganglia section (proximal end, P = 0.000) and centrum semiovale section (distal end, P = 0.001). rCBV at basal ganglia section was significantly increased after operation (P = 0.021), while rCBV at centrum semiovale section had no significant difference compared with before operation (P = 0.844). rMTT (P = 0.000, 0.000) and rTTP (P = 0.000, 0.000) at ipsilateral basal ganglia section and centrum semiovale section were significantly reduced after operation.  Conclusions STA-MCA bypass can improve cerebral blood perfusion of MCA blood supplying area. DSC-PWI could assess the hemodynamics of ischemic area, so it is the optimal noninvasive technology to evaluate the curative effect of bypass and observe cerebral hemodynamic changes dynamically.

DOI: 10.3969/j.issn.1672-6731.2017.06.010