Published Online
on June 10, 2004

A more recent version of this article appeared on August 1, 2004

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Submitted on January 22, 2004
Revised on April 6, 2004
Accepted on May 4, 2004

Diagnostic Impact of Transcranial Color-Coded Real-Time Sonography With Echo Contrast Agents for Hyperperfusion Syndrome After Carotid Endarterectomy

Shigeru Fujimoto MD^*; Kazunori Toyoda MD; Tooru Inoue MD; Yuko Hirai MD; Takeshi Uwatoko MD; Kazuhiro Kishikawa MD; Kotaro Yasumori MD; Setsuro Ibayashi MD; Mitsuo Iida MD; and Yasushi Okada MD

From the Departments of Cerebrovascular Disease (S.F., K.T., Y.H., T.U., K.K., Y.O.), Neurosurgery (T.I.), and Neuroradiology (K.Y.), Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan; and the Department of Medicine and Clinical Science (S.I., M.I.), Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.

^* To whom correspondence should be addressed. E-mail: fujimoto{at}qmed.hosp.go.jp.

Background and Purpose--The purpose of the present study was to evaluate availability of transcranial color-coded real-time sonography (TCCS) to detect hyperperfusion after carotid endarterectomy (CEA).

Methods--This prospective study included 105 consecutive patients who underwent CEA for severe carotid stenosis. TCCS with echo contrast agents was performed serially to evaluate flow velocity of the middle cerebral artery (MCA). Regional cerebral blood flow (rCBF) and vasodilatory capacity of the MCA territory were evaluated using single-photon emission computed tomography. We compared the changes in MCA flow velocity with rCBF.

Results--Using echo contrast agents, we could evaluate the MCA flow in 95 (90%) of 105 patients. Twelve patients showed hyperperfusion syndrome. Changes in the MCA mean flow velocity (MFV) before and 4 days after CEA were significantly correlated with those in rCBF (r=0.48; P<0.0001). An increase of >50% in MCA MFV was observed within 4 days after CEA in all 12 patients with hyperperfusion syndrome. Multivariate analysis revealed that reduced vasodilatory capacity (odds ratio, 0.14; 95% CI, 0.04 to 0.46) was an independent risk factor for a 1.5-fold increase in the MFV of MCA ipsilateral to CEA.

Conclusions--Findings of a 1.5-fold increase in the MCA MFV can accurately identify those patients with high risk of developing post-CEA hyperperfusion syndrome. TCCS with echo contrast agents is available for the evaluation of hyperperfusion after CEA.

Key words: carotid endarterectomy • cerebral blood flow • ultrasonography, Doppler, transcranial • contrast media

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