Relief of nonhemispheric symptoms in low flow states by anterior circulation revascularization: a physiologic approach

Journal Article · Sun Feb 01 00:00:00 EST 1987 · J. Vasc. Surg.; (United States)

DOI:https://doi.org/10.1016/0741-5214(87)90137-6· OSTI ID:6862785

Yonas, H; Steed, D L; Latchaw, R E; Gur, D; Peitzman, A B; Webster, M W

Operative intervention remains controversial for patients with transient nonhemispheric symptoms with occlusive disease of both the anterior and posterior cerebral circulations. In addition to the standard evaluation of these patients, we have used stable xenon-enhanced computed tomographic mapping of cerebral blood flow (Xe/CT CBF). This relatively new and potentially widely available CBF methodology, by measuring approximately 30,000 CBF values within each of three CT levels, provides a readily interpretable means of evaluating extremes of hemodynamic compromise within any or all vascular territories. In the past 30 months, Xe/CT CBF studies in 300 patients with occlusive vascular disease have identified nine patients with global low flow and nonhemispheric symptoms (vertigo, lightheadedness, and/or blurred vision). Blood pressures determined by ocular pneumoplethysmography of Gee were markedly abnormal with reduced ocular/brachial ratios. Each patient had a combination of both segmental carotid and vertebrobasilar occlusive disease. Each patient had a flow-augmenting procedure performed on the anterior circulation in an attempt to improve global flow: carotid endarterectomy (two patients), subclavian-external carotid bypass (one patient), and superficial temporal artery-middle cerebral artery bypass (six patients). In each case disabling transient symptoms were relieved. There were no operative deaths, but one stroke occurred, probably as a result of a brief period of postoperative hypotension. Postoperative Xe/CT CBF studies show a long-term improved global CBF in all patients.

• Research Organization: Univ. of Pittsburgh, PA
• OSTI ID: 6862785
• Journal Information: J. Vasc. Surg.; (United States), Vol. 2
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BRAIN
BLOOD FLOW
EMISSION COMPUTED TOMOGRAPHY
VASCULAR DISEASES
DIAGNOSIS
BLOOD CIRCULATION
PATIENTS
SURGERY
SYMPTOMS
XENON ISOTOPES
BODY
CENTRAL NERVOUS SYSTEM
COMPUTERIZED TOMOGRAPHY
DIAGNOSTIC TECHNIQUES
DISEASES
ISOTOPES
MEDICINE
NERVOUS SYSTEM
ORGANS
TOMOGRAPHY
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