(Stroke. 2001;32:1567.)
© 2001 American Heart Association, Inc.
Original Contributions |
Cerebral Vasoreactivity and Internal Carotid Artery Flow Help to Identify Patients at Risk for Hyperperfusion After Carotid Endarterectomy
From the Department of Neurosurgery, Hyogo Brain and Heart Center, Himeji (K.H., T.K., Y.S., M.K., K.K., J.K., S.F), and Department of Neurosurgery, Kobe University School of Medicine (N.T.) (Japan).
Correspondence to Kohkichi Hosoda, MD, Department of Neurosurgery, Hyogo Brain and Heart Center, 520 Saisho-ko, Himeji 670-0981, Japan. E-mail khosoda{at}venus.dti.ne.jp
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 
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 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 100%. A
significant association of intracerebral steal with
hyperperfusion (CBF increase 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.
Key Words: blood flow • carotid endarterectomy • cerebral blood flow • tomography, emission computed • vasomotor reactivity
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