Assessments of Pre-Surgical Ischemia and Post-Surgical Perfusion Restoration with Tc-99m ECD SPECT in a Patient of Internal Carotid Artery Occlusion Receiving EC-IC Bypass

摘要

A 55-year-old male patient with a history of hypertension, diabetes and hyperlipidemia experienced left hemiplegia. MRI revealed occlusions in bilateral internal carotid arteries and acute infarction in right periventricular white matter. Tc-99m ECD brain perfusion SPECT showed extensive ischemia in bilateral cerebral cortices with right-side predominance. After two months of medical treatment and rehabilitation, right-side extracranial-intracranial (EC-IC) arterial bypass surgery was performed. Although the follow-up MRI showed only chronic change of infarctions in white matters, clinical improvement of neurological deficit was noted after surgical intervention. The follow-up SPECT confirmed the restoration of cerebral perfusion in right cerebral cortex. The serial images studies demonstrated the value of Tc-99m ECD brain perfusion SPECT in the assessments of pre-surgical cerebral ischemia and post-surgical perfusion restoration through EC-IC bypass for the patient with carotid artery occlusion.