Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.14/199629
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- Title
- Mean arterial pressure required for maintaining patency of extracranial-to-intracranial bypass grafts : an investigation with computational hemodynamic models - case series
- Related
- Neurosurgery, Vol. 71, No. 4, (2012), p.826-831
- DOI
- 10.1227/NEU.0b013e318266e6c2
- Publisher
- Lippincott Williams & Wilkins
- Date
- 2012
- Author/Creator
- Sia, Sheau Fung
- Author/Creator
- Qian, Yi
- Author/Creator
- Zhang, Yu
- Author/Creator
- Morgan, Michael Kerin
- Description
- BACKGROUND: Maintaining flow in a newly established high-flow bypass into the intracranial circulation may be threatened by low blood pressure. OBJECTIVE: To identify mean arterial blood pressure below which early graft failure may ensue. METHODS: Computational fluid dynamic blood flow simulation and Doppler ultrasound-derived velocities were combined to study 12 patients with common carotid-to-intracranial (internal carotid artery in 9 and middle cerebral artery in 3) arterial brain bypass with interposition of the saphenous vein. Patients underwent carotid duplex and high-resolution computed tomography angiography to obtain the necessary data. A mean time-averaged pressure gradient across both anastomoses of the graft was then calculated. RESULTS: The bypass graft mean blood flow ± SD was 180.3 ± 76.2 mL/min (95% confidence interval: 132-229). The mean time-averaged pressure gradient ± SD across the bypass graft was 10.2 ± 8.7 mm Hg (95% confidence interval: 4.6-15.7). This compared with a mean pressure gradient ± SD on the contralateral carotid of 21.7 ± 13.8 mm Hg. From these data, the minimum mean ± SD systemic pressure necessary to maintain graft flow of at least 40 mL/min was 61.6 ± 2.31 mm Hg, and the mean peak wall shear stress ± SD at the proximal anastomosis was 0.8 ± 0.7 Pa (95% confidence interval: 0.3-1.2). CONCLUSION: Early postoperative mean arterial pressure less than approximately 60 mm Hg may induce blood flow in the bypass to decrease to less than 40 mL/min, a flow below which low shear stress may lead to early graft occlusion.
- Description
- 6 page(s)
- Subject Keyword
- Blood pressure
- Subject Keyword
- Brain
- Subject Keyword
- Computational fluid dynamic
- Subject Keyword
- EC-IC bypass
- Subject Keyword
- Occlusion
- Subject Keyword
- Surgery
- Resource Type
- journal article
- Organisation
- Macquarie University. Australian School of Advanced Medicine
- Identifier
- http://hdl.handle.net/1959.14/199629
- Identifier
- ISSN:0148-396X
- Identifier
- mq_res-ext-2-s2.0-84866902090
- Language
- eng
- Reviewed
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