Japanese
Title内頸動脈系の慢性閉塞性疾患の脳循環代謝 - 外頸動脈-内頸動脈吻合術の適応についての検討 -
Subtitle原著
Authors日向野修一*, 上村和夫*, 宍戸文男*, 犬上篤*, 戸村則昭*, 藤田英明*, 安陪等思*, 菅野巖*
Authors(kana)
Organization*秋田県立脳血管研究センター放射線医学研究部
Journal核医学
Volume24
Number6
Page809-815
Year/Month1987/6
Article原著
Publisher日本核医学会
Abstract「要旨」脳動脈主幹部の慢性閉塞に対するEC/IC bypass手術の適応の再検討を目的に, 内頸動脈ないし中大脳動脈主幹部に閉塞または高度狭窄を有し, 小梗塞巣のみを認める症例28例を対象に, ポジトロンCTにて脳循環代謝測定を行った. 脳血流量, 酸素消費量は, ともに, 障害側のみならず健側にても正常対象群に比し, 有意に低下していたが, 最低灌流部の局所脳循環代謝値が, われわれの求めた梗塞発生閾値以下を示した例はごくわずかであった. また, 脳血流量と酸素消費量は, ほとんどの症例で相関して減少しており, 血流量の著明な減少にもかかわらず酸素消費量の保たれていた症例は3例とごくわずかであった. これらの3例では, 脳循環予備能の指標である酸素摂取率の異常な上昇を認め, また, 3例中2例では, 血管腔内での血栓形成や塞栓物質の停滞の促進要素となると考えられる平均通過時間の著しい延長を認めた. 以上の結果から手術の適応となると考えられる症例は28例のうちわずか2-3例(7-11%)のみと考えられた.
Practice臨床医学：一般
KeywordsObstructive carotid disease, EC/IC bypass, Positron emission tomography, Cerebral ischemia, Cerebral blood flow.
English
TitleStudies on Cerebral Blood Flow and Oxygen Metabolism in Patients with Chronically Obstructive Carotid Disease, Using Positron Emission Tomography (PET) - In Consideration of the Indication for EC/IC Bypass Surgery -
SubtitleOriginal Articles
AuthorsShuichi HIGANO, Kazuo UEMURA, Atsushi INUGAMI, Fumio SHISHIDO, Noriaki TOMURA, Hideaki FUJITA, Toushi ABE, Iwao KANNO
Authors(kana)
OrganizationDepartment of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita
JournalThe Japanese Journal of nuclear medicine
Volume24
Number6
Page809-815
Year/Month1987/6
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary]Recently a negative result was reported by international co-operative study on EC/IC bypass surgery, but some favorable reports for this surgery have still been reported from the standpoint of cerebral circulation and metabolism. To analyze this disappointing result for the surgery, twenty-eight patients with a chronic occlusion or a severe stenosis of the internal carotid artery or the horizontal portion of the middle cerebral artery, and without a massive low density area on CT were studied using PET and the 15O-steady-state technique. With this method, cerebral blood flow (CBF), oxygen consumption rate (CMRO2), oxygen extraction fraction (OEF) and cerebral blood volume (CBV) were obtained in the normodensity brain on CT. In most patients, CBF and CMRO2 in the carotid territories were diffusely decreased not only in the hemisphere perfused by the diseased artery, but also in the contralateral one. CBF and CMRO2 of the least perfusion tissue in the affected hemispheres were considerably reduced, but mostly were not less than the levels of ischemic thresholds causing tissue necrosis. Only 3 of 28 patients revealed critically decreased CBF with relatively preserving CMRO2 by increased OEF. There was a linear correlation between vascular transit time (CBV/CBF ratio) and OEF. Longest vascular transit times were found in 2 of the 3 patients with increased OEF mentioned above. The coupled decrease of CBF and CMRO2 in the carotid arterial distribution suggests that the structurally normal tissue perfused by diseased artery would have been damaged to some degree by chronically decreased CBF. The prolonged vascular transit time might cause increased risk for thrombosis and so on. In order to obtein successful results from the EC/IC bypass surgery, we should choose patients maintaining CMRO2 by significant increase of OEF and/or with prolonged vascular transit time. In this view, only 2-3 patients of the 28 subjects (7-11%) should be indicated for the surgery.
PracticeClinical medicine
KeywordsObstructive carotid disease, EC/IC bypass, Positron emission tomography, Cerebral ischemia, Cerebral blood flow.

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