Abstract
Background STA-MCA bypass surgery (SMBS) may be considered as a rescue treatment for patients with progressive stroke in the setting of intracranial steno-occlusive cerebrovascular disease despite optimal medical management.The aim of this study was to describe the utility of CT perfusion (CTP) imaging in guiding perioperative haemodynamic care for patients receiving SBMS.
Methods Three patients with persistent neurologic deficits pre-SMBS (n=2) and post-SMBS (n=1) underwent CT perfusion on and off pressor support to assess the impact of pressor support on lesion volumes.
Results In all three patients (aged 41,43 and 44) CTP imaging demonstrated large Tmax>6s lesions volumes (35, 224 and 380mL respectively). CTP lesion volumes were markedly reduced with pre-operative blood pressure augmentation (13,125 and 289mL respectively). However, radiological improvement was not associated with immediate improvement in clinical outcomes.
Conclusion CTP imaging may guide perioperative pressor support care in SMBS. Future studies should determine whether routine use may improve post-operative patient outcomes.
