Cerebral vasoreactivity and internal carotid artery flow help to identify patients at risk for hyperperfusion after carotid endarterectomy

被引:143
作者
Hosoda, K
Kawaguchi, T
Shibata, Y
Kamei, M
Kidoguchi, K
Koyama, J
Fujita, S
Tamaki, N
机构
[1] Hyogo Brain & Heart Ctr, Dept Neurosurg, Himeji, Hyogo 6700981, Japan
[2] Kobe Univ, Sch Med, Dept Neurosurg, Kobe, Hyogo 650, Japan
关键词
blood flow; carotid endarterectomy; cerebral blood flow; tomography; emission computed; vasomotor reactivity;
D O I
10.1161/01.STR.32.7.1567
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Hyperperfusion syndrome is a rare but potentially devastating complication after carotid endarterectomy (CEA), The aim of this study was to investigate whether preoperative measurement of cerebral vasoreactivity (CVR) and intraoperative measurement of internal carotid artery (ICA) flow could identify patients at risk for hyperperfusion after CEA, Methods-For 26 patients with unilateral ICA stenosis greater than or equal to 70%, cerebral blood flow (CBF) and CVR were investigated before and 1 month after CEA, with resting and acetazolamide-challenge single-photon emission CT. CBF on the first postoperative day was also measured. ICA flow was measured before and after reconstruction by electromagnetic flowmeter during surgery. Results-Ipsilateral CBF on the first postoperative day significantly increased relatively (56.6 +/- 53.2%) as well as absolutely (37.9 +/-8.8 to 57.7 +/- 18.0 mL/100 g per minute) in the reduced CVR group (CVR < 12%) but not in the normal CVR group (CVR greater than or equal to 12%) (10.3 +/- 15.5% and 40.6 +/-7.9 to 43.9 +/-5.7 mL/100 g per minute, respectively). One month later, this difference almost disappeared. Two patients showed ipsilateral CBF increase of greater than or equal to 100%. A significant association of intracerebral steal with hyperperfusion (CBF increase greater than or equal to 100%) on the first postoperative day was also observed. ICA flow increase after reconstruction significantly correlated with CBF increase on the first postoperative day in the reduced CVR group but not in the normal CVR group. The threshold of ICA flow increase for hyperperfusion was estimated to be 330 mL/min in the reduced CVR group. Conclusions-Single-photon emission CT with acetazolamide challenge and ICA flow measurement during surgery could identify patients at risk for hyperperfusion after CEA, in whom careful monitoring and control of blood pressure should be initiated even intraoperatively.
引用
收藏
页码:1567 / 1573
页数:7
相关论文
共 40 条
  • [1] Diagnosis and monitoring of cerebral hyperperfusion after carotid endarterectomy with single photon emission computed tomography: Case report
    Baker, CJ
    Mayer, SA
    Prestigiacomo, CJ
    Van Heertum, RL
    Solomon, RA
    [J]. NEUROSURGERY, 1998, 43 (01) : 157 - 160
  • [2] CEREBRAL HYPERPERFUSION AFTER CAROTID ENDARTERECTOMY - A CAUSE OF CEREBRAL-HEMORRHAGE
    BERNSTEIN, M
    FLEMING, JFR
    DECK, JHN
    [J]. NEUROSURGERY, 1984, 15 (01) : 50 - 56
  • [3] Cerebral Blood Flow and Internal Carotid Artery Flow During Carotid Surgery
    Boysen, Gudrun
    Ladegaard-Pedersen, H. J.
    Valentin, N.
    Engell, H. C.
    [J]. STROKE, 1970, 1 (04) : 253 - 260
  • [4] CAROTID-ARTERY DISEASE - EVALUATION WITH ACETAZOLAMIDE-ENHANCED TC-99M HMPAO SPECT
    BURT, RW
    WITT, RM
    CIKRIT, DF
    REDDY, RV
    [J]. RADIOLOGY, 1992, 182 (02) : 461 - 466
  • [5] HYPERPERFUSION POST-ENDARTERECTOMY
    CHAMBERS, BR
    SMIDT, V
    KOH, P
    [J]. CEREBROVASCULAR DISEASES, 1994, 4 (01) : 32 - 37
  • [6] ACETAZOLAMIDE ENHANCED SINGLE PHOTON-EMISSION COMPUTED-TOMOGRAPHY (SPECT) EVALUATION OF CEREBRAL PERFUSION BEFORE AND AFTER CAROTID ENDARTERECTOMY
    CIKRIT, DF
    BURT, RW
    DALSING, MC
    LALKA, SG
    SAWCHUK, AP
    WAYMIRE, B
    WITT, RM
    [J]. JOURNAL OF VASCULAR SURGERY, 1992, 15 (05) : 747 - 754
  • [7] Transcranial Doppler monitoring during carotid endarterectomy helps to identify patients at risk of postoperative hyperperfusion
    Dalman, JE
    Beenakkers, ICM
    Moll, FL
    Leusink, JA
    Ackerstaff, RGA
    [J]. EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 1999, 18 (03) : 222 - 227
  • [8] INFLUENCE OF ACETAZOLAMIDE ON CEREBRAL BLOOD FLOW
    EHRENREICH, D
    BURNS, RA
    FAZEKAS, JF
    ALMAN, RW
    [J]. ARCHIVES OF NEUROLOGY, 1961, 5 (02) : 227 - &
  • [9] FUJITA S, 1995, SURG CEREB STROKE, V23, P145
  • [10] CHANGES IN INTERNAL CAROTID BLOOD-FLOW AFTER CAROTID ENDARTERECTOMY CORRELATE WITH PREOPERATIVE STENOSIS
    GORDON, IL
    STEMMER, EA
    WILLIAMS, RA
    ARAFI, M
    WILSON, SE
    [J]. AMERICAN JOURNAL OF SURGERY, 1994, 168 (02) : 127 - 130