Background: STA-MCA bypass surgery (SMBS) may be considered as a rescue treatment for patients with progressive stroke in the setting of intracranial steno-occlusive cerebrovascular disease despite optimal medical management.
Aims: The aim of this study was to describe the utility of CT perfusion (CTP) imaging in guiding perioperative haemodynamic care for patients receiving SBMS.
Methods: Three patients with persistent neurologic deficits pre-SMBS (n=2) and post-SMBS (n=1) underwent CT perfusion on and off pressor support to assess the impact of pressor support on lesion volumes.
Results: In all three patients (aged 41,43 and 44) CTP imaging demonstrated large Tmax>6s lesions volumes (35, 224 and 380mL respectively). CTP lesion volumes were markedly reduced with pre-operative blood pressure augmentation (13,125 and 289mL respectively). However, radiological improvement was not associated with immediate improvement in clinical outcomes.
Conclusion: CTP imaging may guide perioperative pressor support care in SMBS. Future studies should determine whether routine use may improve post-operative patient outcomes.