皮質動脈内圧の実験的臨床的意義について

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Intraarterial Pressure (IAP) of cortical MCA has been measured on 19 patients at the time of STA-MCA bypass for the treatment of cerebrovascular occlusive disease since 1973. The value of IAP has been considered to predict the degree of postoperative neurological improvement in stroke patients or to reflect the amplitude of N1-N2 component in the SEP. Clinically IAP was quite variable in the patients with ICA occlusion. IAP was lower in the patient with MCA stenosis (m=56mmHg) and MCA occlusion (m=44mmHg). Patients with Moyamoya disease had the lowest values of all (m=17mmHg). IAP seems to reflect mainly leptomeningeal anastomosis in the MCA occlusion and intraparenchymal anastomosis in Moyamoya disease. IAP in the patient with stroke revealed lower values (30.5±29.3mmHg) than the patients with TIA, or RIND (55±10mmHg, 56±18.5mmHg). Generally speaking, IAP reflected more or less the value of rCBF measured with Xe<SUP>133</SUP> clearance method.<BR>Relationship between cortical IAP and CBF was investigated using hydrogen clearance method on experimental ischemia in dogs. MCA occlusion alone resulted in IAP drop only to 40% and occlusion of the ACA, ICA, PCom, MCA altogether to 35%. IAP of 60 mmHg seems to be critical; lCBF remains unchanged about 93 ml/100 gr./min above the value and drops parallel with IAP thereafter. Thus the same critical IAP might exist also in the clinical patient, below which rCBF would drop parallel with IAP and might lie between 45-50mmHg.
The Japanese Society on Surgery for Cerebral Strokeの論文

皮質動脈内圧の実験的臨床的意義について

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