Analysis of cerebral perfusion and metabolism assessed with positron emission tomography before and after carotid artery stenting

Matsubara, Shunji; Moroi, Junta; Suzuki, Akifumi; Sasaki, Masahiro; Nagata, Ken; Kanno, Iwao; Miura, Shuichi

doi:10.3171/2008.09.17663

Cited by 41 publications

(34 citation statements)

References 29 publications

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“…Accordingly, the preoperative decreased cerebral perfusion pressure increased rapidly within 2 to 7 days of surgery. However, the only PET study on postoperative hyperperfusion after CAS (Matsubara et al, 2009) showed significant increases in CBF and CBF/CBV ratios despite the lack of significant changes in CBV during the acute stage. Interestingly, such PET findings were observed in the contralateral hemisphere during the acute stage after CAS.…”

Section: Mechanism Of Hyperperfusion In Moyamoya Diseasementioning

confidence: 94%

Cerebral Blood Flow and Metabolism of Hyperperfusion after Cerebral Revascularization in Patients with Moyamoya Disease

Kaku

Iihara

Nakajima

et al. 2012

J Cereb Blood Flow Metab

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In moyamoya disease (MMD), surgical revascularization may be complicated with postoperative hyperperfusion. We analyzed cerebral perfusion and metabolism using positron emission tomography (PET) or single-photon emission computed tomography (SPECT) before and after bypass surgery on 42 sides of 34 adult patients with MMD. In seven cases (16.7%) with symptomatic hyperperfusion, diagnosed by qualitative 123 I-iodoamphetamine (IMP) SPECT, a subsequent PET study during postoperative subacute stages revealed significantly increased cerebral blood flow (CBF) from 34.1 ± 8.2 to 74.3 ± 12.8 mL/100 g per minute (P < 0.01), a persistent increase in cerebral blood volume (CBV) from 5.77±1.67 to 7.01±1.44 mL/100 g and a significant decrease in oxygen extraction fraction (OEF) from 0.61 ± 0.09 to 0.40 ± 0.08 (P < 0.01). Mean absolute CBF values during symptomatic hyperperfusion were more than the normal control + 2 standard deviations, the predefined criteria of PET. Interestingly, two patients with markedly increased cerebral metabolic rate of oxygen (CMRO 2 ) at hyperperfusion were complicated with postoperative seizure. Among preoperative PET parameters, increased OEF was the only significant risk factor for symptomatic hyperperfusion (P < 0.05). This study revealed that symptomatic hyperperfusion in MMD is characterized by temporary increases in CBF > 100% over preoperative values caused by prolonged recovery of increased CBV.

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Section: Mechanism Of Hyperperfusion In Moyamoya Diseasementioning

confidence: 94%

Cerebral Blood Flow and Metabolism of Hyperperfusion after Cerebral Revascularization in Patients with Moyamoya Disease

Kaku

Iihara

Nakajima

et al. 2012

J Cereb Blood Flow Metab

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“…The exhausted metabolic reserve can lead to selective neuronal loss in the cortex; this cannot be detected by morphological imaging (CT or MRI) but can be documented by FMZ-PET [72] . Removal of the arterial lesion by endarterectomy or stenting is successful in preventing further ischemic attacks; repeated multiparametric PET can reveal accompanying improvements in CBF, perfusion pressure, and oxygen metabolism [73] .…”

Section: Hemodynamic and Metabolic Reservementioning

confidence: 99%

PET imaging in ischemic cerebrovascular disease: current status and future directions

Heiss

2014

Neurosci. Bull.

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Cerebrovascular diseases are caused by interruption or significant impairment of the blood supply to the brain, which leads to a cascade of metabolic and molecular alterations resulting in functional disturbance and morphological damage. These pathophysiological changes can be assessed by positron emission tomography (PET), which permits the regional measurement of physiological parameters and imaging of the distribution of molecular markers. PET has broadened our understanding of the fl ow and metabolic thresholds critical for the maintenance of brain function and morphology: in this application, PET has been essential in the transfer of the concept of the penumbra (tissue with perfusion below the functional threshold but above the threshold for the preservation of morphology) to clinical stroke and thereby has had great impact on developing treatment strategies. Radioligands for receptors can be used as early markers of irreversible neuronal damage and thereby can predict the size of the fi nal infarcts; this is also important for decisions concerning invasive therapy in large ("malignant") infarctions. With PET investigations, the reserve capacity of blood supply to the brain can be tested in obstructive arteriosclerosis of the supplying arteries, and this again is essential for planning interventions. The effect of a stroke on the surrounding and contralateral primarily unaffected tissue can be investigated, and these results help to understand the symptoms caused by disturbances in functional networks. Chronic cerebrovascular disease causes vascular cognitive disorders, including vascular dementia. PET permits the detection of the metabolic disturbances responsible for cognitive impairment and dementia, and can differentiate vascular dementia from degenerative diseases. It may also help to understand the importance of neuroinfl ammation after stroke and its interaction with amyloid deposition in the development of dementia. Although the clinical application of PET investigations is limited, this technology had and still has a great impact on research into cerebrovascular diseases.

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“…Other unknown factors must play an important role in the perfusion modifications before and after the treatment of carotid artery stenosis. This increased flow in the contralateral hemisphere may occur via collateral circulation through the anterior communicating artery (Tavares et al, 2010) or from the leptomeningeal anastomosis (Matsubara et al, 2009). …”

Section: Pwimentioning

confidence: 99%

“…Because CAS induces changes in cerebral perfusion, it has the inherent although low risk of complications related to increased cerebral blood flow such as reperfusion syndrome (Matsubara et al, 2009;Morrish et al, 2000;Tavares et al, 2010) and even fatal hemorrhagic complications (Hartmann et al, 2004;Morrish et al, 2000). Patients who receive endarterectomies are exposed to similar risks (Bodenant et al, 2010).…”

Section: Reperfusion Syndromementioning

confidence: 99%

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Decreased Cerebral Perfusion in Carotid Artery Stenosis, Carotid Angioplasty and Its Effects on Cerebral Circulation

Tavares¹,

Caldas²

2012

Advances in the Treatment of Ischemic Stroke

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Analysis of cerebral perfusion and metabolism assessed with positron emission tomography before and after carotid artery stenting

Cited by 41 publications

References 29 publications

Cerebral Blood Flow and Metabolism of Hyperperfusion after Cerebral Revascularization in Patients with Moyamoya Disease

Cerebral Blood Flow and Metabolism of Hyperperfusion after Cerebral Revascularization in Patients with Moyamoya Disease

PET imaging in ischemic cerebrovascular disease: current status and future directions

Decreased Cerebral Perfusion in Carotid Artery Stenosis, Carotid Angioplasty and Its Effects on Cerebral Circulation

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