scholarly journals Quantitative angiographic haemodynamic evaluation of bypasses for complex aneurysms: a preliminary study

2021 ◽  
pp. svn-2021-000858
Author(s):  
Junlin Lu ◽  
Chao Xue ◽  
Xulin Hu ◽  
Yuanli Zhao ◽  
Dong Zhang ◽  
...  
Keyword(s):  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Preoperative Evaluation ◽  
Neurological Deficits ◽  
Flow Index ◽  
Flow Measurements ◽  
Complex Aneurysms ◽  
Preliminary Study ◽  
Blood Flow Measurements ◽  
Arterial Anatomy

ObjectiveOpen microsurgery, often with bypass techniques, is indispensable for complex aneurysms. To date, it remains unknown whether arterial anatomy or quantitative blood flow measurements can predict insufficient flow-related stroke (IRS). The present study aimed to evaluate the risk factors for IRS in patients treated with open microsurgery with bypass procedures for complex internal carotid artery aneurysms.MethodsPatients with complex aneurysms undergoing bypass surgery were retrospectively reviewed. The recipient/donor flow index (RDFI) was preoperatively evaluated using colour-coding angiography. RDFI was defined as the ratio of the cerebral blood volume of the recipient and donor arteries. The sizes of the recipient and donor arteries were measured. The recipient/donor diameter index (RDDI) was then calculated. IRS was defined as the presence of new postoperative neurological deficits and infarction on postoperative CT scans. We assessed the association between RDFI and other variables and the IRS.ResultsTwenty patients (38±12 years) were analysed. IRS was observed in 12 patients (60%). Patients with postoperative IRS had a higher RDFI than those without postoperative IRS (p<0.001). RDDI was not significantly different between patients with and without IRS (p=0.905). Patients with RDFI >2.3 were more likely to develop IRS (p<0.001).ConclusionQuantitative digital subtraction angiography enables preoperative evaluation of cerebral blood volume. RDFI >2.3, rather than RDDI, was significantly associated with postoperative IRS. This preoperative evaluation allows appropriate decisions regarding the treatment strategy for preventing postoperative IRS.

Effects of subarachnoid hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans

1977 ◽  
Vol 46 (4) ◽  
pp. 446-453 ◽  
Author(s):  
Robert L. Grubb ◽  
Marcus E. Raichle ◽  
John O. Eichling ◽  
Mokhtar H. Gado
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Blood Volume ◽  
Cerebral Vasospasm ◽  
Cerebral Blood Volume ◽  
Neurological Deficits ◽  
Regional Cerebral Blood ◽  
Oxygen Utilization ◽  
Ruptured Intracranial Aneurysm ◽  
Regional Cerebral Blood Volume

✓ Forty-five studies of regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and regional cerebral oxygen utilization (rCMRO2) were performed in 30 patients undergoing diagnostic cerebral angiography for evaluation of a subarachnoid hemorrhage due to a ruptured intracranial aneurysm. Tracer methods employing radioactive oxygen-15 were used to measure rCBV, rCBF, and rCMRO2. The patient studies were divided into groups based on their neurological status and the presence or absence of cerebral vasospasm. Subarachnoid hemorrhage, with and without vasospasm, produced significant decreases in CBF and CMRO2. In general, patients with more severe neurological deficits, and patients with more severe degrees of vasospasm, had a more marked depression of CBF and CMRO2. The most striking finding was a significant (p < 0.001) increase in CBV (to 58% above normal) in patients with severe neurological deficits associated with severe cerebral vasospasm. This large increase suggests that cerebral vasospasm consists of constriction of the large, radiographically visible extraparenchymal vessels accompanied by a massive dilation of intraparenchymal vessels.

Mismatch between Cerebral Blood Volume and Flow Index during Transient Focal Ischemia Studied with MRI and Gd-BOPTA

1998 ◽  
Vol 16 (2) ◽  
pp. 97-103 ◽  
Author(s):  
F. Caramia ◽  
Z. Huang ◽  
L.M. Hamberg ◽  
R.M. Weisskoff ◽  
G. Zaharchuk ◽  
...  
Keyword(s):  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Focal Ischemia ◽  
Flow Index ◽  
Transient Focal Ischemia

The Cut Flow Index: An Intraoperative Predictor of the Success of Extracranial-Intracranial Bypass for Occlusive Cerebrovascular Disease

2005 ◽  
Vol 56 (suppl_1) ◽  
pp. ONS-75-ONS-85 ◽  
Author(s):  
Sepideh Amin-Hanjani ◽  
Xinjian Du ◽  
Nada Mlinarevich ◽  
Guido Meglio ◽  
Meide Zhao ◽  
...  
Keyword(s):  
Occlusive Disease ◽  
Flow Index ◽  
Bypass Flow ◽  
Flow Measurements ◽  
Cerebrovascular Reserve ◽  
Recipient Vessel ◽  
Bypass Patency ◽  
Graft Success ◽  
Blood Flow Measurements ◽  
Cerebrovascular Occlusive Disease

Abstract OBJECTIVE: There has been a resurgence of interest in selective extracranial-intracranial bypass for revascularization of cerebrovascular occlusive disease. We evaluated the usefulness of intraoperative blood flow measurements in predicting graft success after extracranial-intracranial bypass. METHODS: A retrospective review of 51 cases of extracranial-intracranial bypass for purposes of flow augmentation in the setting of cerebrovascular occlusive disease was performed. In all cases, free flow from the cut end of the donor vessel, termed cut flow, was measured. The cut flow index (CFI) (bypass flow [ml/min] / cut flow [ml/min]) was derived and correlated with bypass patency, postoperative bypass flow, cerebrovascular reserve testing, and clinical outcome. RESULTS: The CFI was a significant predictor of bypass patency (P = 0.002). Using a CFI of 0.5 as a threshold, the bypass patency rate was 92% in cases with a CFI greater than 0.5 compared with 50% in cases with a CFI less than 0.5. Intraoperative bypass flow correlated well with postoperative measurements obtained from quantitative phase-contrast magnetic resonance imaging. An analysis of cases with a poor CFI indicated that a logical interpretation of bypass function can be performed during surgery. CONCLUSION: A poor CFI can alert surgeons to potential difficulties with the donor vessel, anastomosis, or recipient vessel during surgery. Furthermore, a CFI closely approximating 1.0 provides physiological confirmation of impaired cerebrovascular reserve in the recipient bed.

scholarly journals Intraprocedural Detection of Cerebral Hyperperfusion by Flat Detector Computed Tomography in the Evaluation of Cerebral Blood Volume during Carotid Artery Stenting

2014 ◽  
Vol 20 (4) ◽  
pp. 502-509 ◽  
Author(s):  
Yukinori Terada ◽  
Taketo Hatano ◽  
Yasunori Nagai ◽  
Makoto Hayase ◽  
Masashi Oda ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Blood Volume ◽  
Carotid Artery Stenting ◽  
Cerebral Blood Volume ◽  
Present Report ◽  
Neurological Deficits ◽  
Flat Detector ◽  
Cerebral Hyperperfusion ◽  
Angiography Suite

Cerebral blood volume (CBV) can be measured using a C-arm flat detector angiographic system. The present report describes a case in which cerebral hyperperfusion was detected with the Neuro parenchymal blood volume (PBV) system (syngo Neuro PBV IR, Siemens Medical Solutions, Erlangen, Germany) during carotid artery stenting (CAS). An 89-year-old man was referred to our hospital for cerebral brain infarction and severe stenosis of the left carotid artery. CAS was performed, and Neuro PBV was used to measure CBV both during and after the procedure. Postoperative Neuro PBV revealed dramatically increased CBV, and a hyperperfusion state was suspected. The next day, subarachnoid hemorrhage along the sulcus of the left hemisphere was revealed on computed tomography. Strict management of blood pressure was instituted just after the detection of hyperperfusion, and the patient was ultimately discharged from the hospital without any new neurological deficits. Neuro PBV has the advantage that it can be performed in the angiography suite and does not require patient transfer to an alternate setting. Therefore, intracranial hemodynamic changes can be detected during the procedure. We conclude that the Neuro PBV system is useful for monitoring intracranial hemodynamics during endovascular procedures.

scholarly journals Absolute Cerebral Blood Volume and Blood Flow Measurements Based on Synchrotron Radiation Quantitative Computed Tomography

2003 ◽  
Vol 23 (4) ◽  
pp. 499-512 ◽  
Author(s):  
Jean-François Adam ◽  
Hélène Elleaume ◽  
Géraldine Le Duc ◽  
Stéphanie Corde ◽  
Anne-Marie Charvet ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Blood Flow ◽  
Synchrotron Radiation ◽  
Contrast Agent ◽  
Blood Volume ◽  
Cerebral Blood Volume ◽  
Quantitative Computed Tomography ◽  
Contrast Material ◽  
Flow Measurements ◽  
Computed Tomography Images

Synchrotron radiation computed tomography opens new fields by using monochromatic x-ray beams. This technique allows one to measure in vivo absolute contrast-agent concentrations with high accuracy and precision, and absolute cerebral blood volume or flow can be derived from these measurements using tracer kinetic methods. The authors injected an intravenous bolus of an iodinated contrast agent in healthy rats, and acquired computed tomography images to follow the temporal evolution of the contrast material in the blood circulation. The first image acquired before iodine infusion was subtracted from the others to obtain computed tomography slices expressed in absolute iodine concentrations. Cerebral blood volume and cerebral blood flow maps were obtained after correction for partial volume effects. Mean cerebral blood volume and flow values (n = 7) were 2.1 ± 0.38 mL/100 g and 129 ± 18 mL · 100 g–1 · min–1 in the parietal cortex; and 1.92 ± 0.32 mL/100 g and 125 ± 17 mL · 100 g–1 · min–1 in the caudate putamen, respectively. Synchrotron radiation computed tomography has the potential to assess these two brain-perfusion parameters.

scholarly journals Monoexponential Analysis of 133Xe Clearance Curves for Regional Cerebral Blood Flow Measurements

1984 ◽  
Vol 4 (2) ◽  
pp. 250-258 ◽  
Author(s):  
Erik Ryding
Keyword(s):  
Weight Ratio ◽  
Input Function ◽  
Low Flow ◽  
Flow Index ◽  
Flow Measurements ◽  
Clearance Curve ◽  
Flow Components ◽  
The One ◽  
Blood Flow Measurements ◽  
Fast Flow

The theoretical properties of a monoexponential flow index, analogous to the one used earlier by other investigators for regional CBF (rCBF) measured after intraarterial injection, were investigated after the administration of 133Xe intraarterially, intravenously, and by inhalation under high and low flow conditions. The sensitivity of the flow index to changes in fast flow components or changes in the weight ratio between the fast and the slow flow compartments was found to be dependent on whichever part of the 133Xe clearance curve was used for the flow calculation and on the shape of the input function for 133Xe. Since biexponential analysis of the clearance curves includes a monoexponential approximation for each of the two components of the clearance curve corresponding to the high and the low flow “families” in the brain, the limitations of the monoexponential flow index observed are in principle also valid for the results of biexponential analysis of the clearance curves.

The cut flow index revisited: utility of intraoperative blood flow measurements in extracranial-intracranial bypass surgery for ischemic cerebrovascular disease

2020 ◽  
Vol 133 (5) ◽  
pp. 1396-1400 ◽  
Author(s):  
Christopher J. Stapleton ◽  
Gursant S. Atwal ◽  
Ahmed E. Hussein ◽  
Sepideh Amin-Hanjani ◽  
Fady T. Charbel
Keyword(s):  
Blood Flow ◽  
Cerebrovascular Disease ◽  
Bypass Surgery ◽  
Flow Index ◽  
Flow Measurements ◽  
Ischemic Cerebrovascular Disease ◽  
Bypass Patency ◽  
Blood Flow Measurements

OBJECTIVEIn extracranial-intracranial (EC-IC) bypass surgery, the cut flow index (CFI) is the ratio of bypass flow (ml/min) to donor vessel cut flow (ml/min), and a CFI ≥ 0.5 has been shown to correlate with bypass patency. The authors sought to validate this observation in a large cohort of EC-IC bypasses for ischemic cerebrovascular disease with long-term angiographic follow-up.METHODSAll intracranial bypass procedures performed at a single institution between 2003 and 2018 were reviewed. Demographic, clinical, angiographic, and operative data were recorded and analyzed according to bypass patency with univariate and multivariate statistical analyses.RESULTSA total of 278 consecutive intracranial bypasses were performed during the study period, of which 157 (56.5%) were EC-IC bypasses for ischemic cerebrovascular disease. Intraoperative blood flow measurements were available in 146 patients, and angiographic follow-up was available at a mean of 2.1 ± 2.6 years after bypass. The mean CFI was significantly higher in patients with patent bypasses (0.92 vs 0.64, p = 0.003). The bypass patency rate was 83.1% in cases with a CFI ≥ 0.5 compared with 46.4% in cases with a CFI < 0.5 (p < 0.0001). Adjusting for age, sex, diagnosis, and single versus double anastomosis, the CFI remained a significant predictor of bypass patency (p = 0.001; OR 5.8, 95% CI 2.0–19.0). A low CFI was also associated with early versus late bypass nonpatency (p = 0.008).CONCLUSIONSA favorable CFI portends long-term EC-IC bypass patency, while a poor CFI predicts eventual bypass nonpatency and can alert surgeons to potential problems with the donor vessel, anastomosis, or recipient bed during surgery.

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