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.
机构:
INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
CIKRIT, DF
BURT, RW
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
BURT, RW
DALSING, MC
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
DALSING, MC
LALKA, SG
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
LALKA, SG
SAWCHUK, AP
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
SAWCHUK, AP
WAYMIRE, B
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
WAYMIRE, B
WITT, RM
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
机构:
St Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, NetherlandsSt Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, Netherlands
Dalman, JE
Beenakkers, ICM
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St Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, NetherlandsSt Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, Netherlands
Beenakkers, ICM
Moll, FL
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St Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, NetherlandsSt Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, Netherlands
Moll, FL
Leusink, JA
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St Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, NetherlandsSt Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, Netherlands
Leusink, JA
Ackerstaff, RGA
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St Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, NetherlandsSt Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, Netherlands
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
CIKRIT, DF
BURT, RW
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
BURT, RW
DALSING, MC
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
DALSING, MC
LALKA, SG
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
LALKA, SG
SAWCHUK, AP
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
SAWCHUK, AP
WAYMIRE, B
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
WAYMIRE, B
WITT, RM
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INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202INDIANA UNIV,RICHARD L ROUDEBUSH VET ADM HOSP,MED CTR,DEPT RADIOL,INDIANAPOLIS,IN 46202
机构:
St Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, NetherlandsSt Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, Netherlands
Dalman, JE
Beenakkers, ICM
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St Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, NetherlandsSt Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, Netherlands
Beenakkers, ICM
Moll, FL
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St Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, NetherlandsSt Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, Netherlands
Moll, FL
Leusink, JA
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St Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, NetherlandsSt Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, Netherlands
Leusink, JA
Ackerstaff, RGA
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St Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, NetherlandsSt Antonius Hosp, Dept Clin Neurophysiol, NL-3430 EM Nieuwegein, Netherlands