脳卒中の外科
Online ISSN : 1880-4683
Print ISSN : 0914-5508
ISSN-L : 0914-5508
原  著
EC-M2バイパスにおける中大脳動脈圧モニターの有用性と留意点
太田 仲郎谷川 緑野坪井 俊之野田 公寿茂宮崎 貴則木下 由宇松川 東俊榊原 史啓齊藤 寛浩上山 博康徳田 禎久
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2018 年 46 巻 2 号 p. 148-154

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Introduction: Monitoring for intra-operative patency of the extracranial (EC)-M2 bypass is important to avoid ischemic complications. Tools such as ultrasound micro-flow probe and indocyanine green videoangiography are commonly used for EC-M2 monitoring. Middle cerebral artery pressure (MCAP) monitoring is another tool to assess the patency of the EC-intracranial (IC) bypass. We retrospectively analyze and discuss a series of cases of EC-M2 bypass with MCAP monitoring.
Methods: We performed EC-M2 bypass with MCAP monitoring in 84 patients at our institution. Before EC-M2 bypass, we performed superficial temporal artery (STA)-MCA bypass, and MCAP was measured through another branch of the STA.
Initial MCAP (iMCAP), MCAP after clamping of the ICA (cMCAP), and MCAP after releasing the graft (actual gMCAP) were intraoperatively monitored. The MCAP ratio was defined as gMCAP/iMCAP. On the basis of the Hagen-Poiseuille's law, the expected MCAP ratio (expected gMCAP/iMCAP) was hypothesized as: (1-cMCAP/iMCAP)(graft radius/ICA radius)2 + cMCAP/iMCAP. Graft malfunction was defined as a discrepancy between the expected gMCAP and actual gMCAP.
Results: Eight of 84 cases were judged to have graft malfunction by MCAP monitoring and had to be re-anastomosed.
The cause of graft malfunction was twisting of the graft in one case, insufficient graft length in 2 cases, severe atherosclerosis of the external carotid artery in 3 cases, M2 proximal twisting owing to pressure of the EC-M2 bypass in one case, and kinking due to an elongated styloid process in one case. After re-anastomosis, the MCAP in 7 cases improved, whereas in 1 case, acute graft occlusion after operation was seen.
Conclusions: MCA pressure monitoring, combined with other monitoring tools, is effective for assessing graft malfunction during surgery and can help achieve favorable patency of the EC-M2 bypass.

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© 2018 一般社団法人 日本脳卒中の外科学会
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