SPM analysis of basal/acetazolamide Tc-99m ECD brain perfusion SPECT for hemodynamic efficacy of endovascular stent placement of middle cerebral artery stenosis

The aim of this study was to evaluate the hemodynamic changes after endovascular stent placement in patients with unilateral middle cerebral artery(MCA) stenosis using basal/acetazolamide (ACZ) Tc-99m ECD brain perfusion SPECT. Eight patients (4 men and 4 women, the mean age of 63.4±11.2 year) who underwent endovascular stent placement for unilateral MCA stenosis were enrolled. Basal/ACZ Tc-99m ECD brain perfusion SPECT studies were performed 14 days before and 7 days after endovascular stent placement. The vascular reserve study was performed by one-day protocol. Using statistical parametric mapping (SPM) analysis, we compared cerebral perfusion and vascular reserves of the pre-stenting studies with those of the post-stenting studies. Results of brain perfusion SPECT with SPM analysis are as follow: 1) Five of eight patients showed improvement of the basal perfusion after endovascular stent placement on brain perfusion SPECT. Of five patients with improvement of the basal perfusion, three patients showed improvement of the vascular reserve after endovascular stent placement. 2) two out of eight patients showed no interval change of the basal perfusion, and one of two patients with no interval change of the basal perfusion showed improvement of the vascular reserve after endovascular stent placement. One of eight patients showed more reduction of the basal perfusion and more reduction of vascular reserve. 3) SPM analysis of basal/ACZ brain perfusion SPECT showed that the endovascular stent placement was beneficial in six patients who had improvement of perfusion or vascular reserve, but the stent placement was found to be not beneficial in two patients with no interval change or with more reduction of perfusion and vascular reserve. This study revealed the usefulness of basal/ACZ brain perfusion SPECT after MCA stent placement. SPM analysis of basal/ACZ brain perfusion SPECT would be helpful to evaluate the hemodynamic efficacy of MCA stent placement