Occlusive cerebro-vascular disease

1)     Carotid stenosis

a. Workup

- Carotid doppler /coronary angiography

- CT angiography including carotid

- brain MRI+A including carotid

- brain SPECT (Diamox study, if indicated)

 

b. Postoperative management

1. strict BP control!! : 수술 후 1주간, 특히 POD~2일째 까지의 혈압조절은 critical!

  A. SBP<150mmHg

  B. 환자가 두통/seizure 등 neurologic chage 있으면 Hyperperfusion syndrome 가능성 의심해야 하고, 특히 infarction 있는 환자에서는 출혈 위험성 높다.

 

2)     Moyamoya disease ★

 a. Workup

  - Perfusion study: CT or MR / Brain Diamox SPECT

  - 6 vessel TFCA

 b. Suzuki classification of moyamoya disease

Grade	Definition
I	Narrowing the apex of the ICA
II	Incipient Moyamoya vessels
III	Progressive stenosis of the ICA and intensification of Moyamoya vessels
IV	Development of collaterals from the ECA
V	Intensification of ECA collaterals and reduction of Moyamoya vessels
VI	ICA occlusion and disappearance of Moyamoya vessels

* Stage II에서 III 로 갈때와 III에서 IV로 갈 때 증상이 심해진다. Stage V 이상이면 수술 할 필요 없다.