中大脳動脈閉塞性病変に対するSTA-MCA吻合術の血行動態モデル解析

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Although superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis has been considered to be a safe surgical procedure for middle cerebral artery (MCA) stenosis, a few post-operative ischemic events as well as progression from stenosis to occlusion have been reported. One effective means of studying these problems is to evaluate the hemodynamic changes associated with anastomosis using a hydraulic model. A model of the anterior circulation of the circle of Willis, similar in its dimensions to that of an average adult human, was constructed of glass and silicone tubes. After adjusting the blood flow and pressure to correspond to those of human major cerebral arteries, the proximal MCA (M_1 portion) was occluded in stages with or without STA-MCA anastomosis. Throughout these procedures, blood flow was measured, either by an electromagnetic flowmeter or by the drop counting method, in the proximal MCA, distal MCAs, and STA. With varying degrees of M_1 stenosis, distal MCA flow increased after STA-MCA anastomosis. The increment, however, was usually smaller than that of the STA inflow volume, and this was ascribed to the concomitant decrease in M_1 flow. The degree of flow changes was found to depend largely on the flow volume of the cut STA or the diameter of the STA. When the M_1 stenosis was mild (around 20%), a steady increase in distal MCA flow and a marked decrease in M_1 flow were observed with the increase of the STA diameter. Under moderate M_1 stenosis (about 40% and 60%), not only a marked increase in distal MCA flow but also a steady decrease in M_1 flow were found. When the stenosis had progressed to about 80%, the distal MCA flow increased markedly, in proportion to the increasing diameter of the STA, while the M_1 flow did not change. In conclusion, from a biorheological point of view, the decreased M_1 flow observed after STA-MCA anastomosis is considered to play an important role in the progression of the stenosis to occlusion.
日本脳神経外科学会の論文
1987-10-15

中大脳動脈閉塞性病変に対するSTA-MCA吻合術の血行動態モデル解析

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