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Intraoperative assessment of cerebral blood flow using ASL MRI during surgical revascularization for chronic cerebral ischemiaтезисы доклада
- Авторы: SHULGINA Anna, LUKSHIN Vasily, USACHEV Dmitry
- Сборник: The 67th Annual Meeting of the Japanese Society of Cerebral Blood Flow and Metabolism (BRAIN Japan 2024) Abstract book
- Тезисы
- Год издания: 2024
- Место издания: Japanese Society of Cerebral Blood Flow and Metabolism Toyama, Japan Toyama, Japan
- Первая страница: 54
- Последняя страница: 54
- Номер статьи: S1-4
- Аннотация: Background The effectiveness of surgical revascularization in patients with chronic cerebral ischemia directly depends on the degree of restoration of cerebral blood flow. The current methods do not take into account dynamic changes in cerebral perfusion after the bypass. Intraoperative ASL MRI allows to determine the tactics of revascularization using single or double bypasses directly during the surgical intervention. Objectives(or Aim) Development of principles for dynamic assessment of cerebral blood flow (CBF) using intraoperative (io) MR ASL perfusion study during surgical revascularization in patients with chronic cerebral ischemia to determine indications for additional bypasses. Methods During 2022-2024, 72 patients underwent surgical revascularization using ioMRI (36 patients with ICA/MCA occlusion and 36 patients with Moyamoya disease or syndrome). All patients under general anesthesia underwent MRI including ASL with mild hypercapnia (to determine cerebrovascular reactivity) before surgery. After application of the first bypass, all patients underwent ioMRI (ASL) to determine the localization of areas of residual hypoperfusion, signs of local hyperperfusion and determine indications or contraindications for additional revascularization with a second donor branch. Result In all cases, use of ioMRI made it possible to determine the tactics of revascularization directly during surgery using one or two bypasses. In 34 cases, ioMRI confirmed targeted improvement in CBF in the entire hemisphere or MCA region after single bypass. In 23 cases, a single bypass was not enough for the targeted CBF restoration; these patients underwent additional revascularization with a second donor branch (32%). In all cases, it was possible to achieve a significant quantitative improvement in CBF and the volume of brain tissue with restored blood flow in ASPECTS scores. In the group of patients after applying a single bypass, there was an increase in CBF values and areas of restored blood flow by almost 2 times (22.7±9.6 ml/100 g/min and 4.7±1.8 points on the ASPECTS scale before surgery versus 39,4±16.4 ml/100 g/min and 4.7±1.8 points after bypass). In the double bypass group, there was an increase in these indicators by almost 3 times (18±3.1 ml/100 g/min and 3.8±0.9 ASPECTS scores before surgery versus 57±11.4 ml/100 g/min and 7.7±1.5 points after). Conclusion IoASL-MRI is an effective and informative tool for determining the degree of CBF restoration directly during surgery, which allows for timely adjustment of surgical treatment tactics, determining indications or contraindications for additional revascularization and excluding early ischemic complications.
- Добавил в систему: Шульгина Анна Алексеевна