Evaluation of carotid distal pressure for prevention of hyperperfusion after carotid endarterectomy

Yoshimoto, Tetsuyuki; Shirasaka, Tomohide; Yoshizumi, Takeshi; Fujimoto, Shin; Kaneko, Sadao; Kashiwaba, Takeshi

doi:10.1016/j.surneu.2004.06.016

Cited by 19 publications

(21 citation statements)

References 9 publications

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“…Furthermore, the pressure measured at the distal portion of the ipsilateral carotid artery (distal pressure) appeared to be closely related to the postoperative hyperperfusion in such high risk patients. 11) The distal pressure indicating the development of collateral flow revealed chronic exposure to hypoperfusion in one patient with severe stenosis. Patients with distal pressure below 40 mmHg or high delta pressure might have higher risk of hyperperfusion.…”

Section: Discussionmentioning

confidence: 94%

“…1,3,6,7) Preoperatively, patients with a high risk of postoperative hyperperfusion can be identified based on preoperative perfusion data such as severe hypoperfusion and poor cerebrovascular reserve (CVR) below 10%, 10) and intraoperative stump pressure below 40 mmHg. 11) In such patients, blood pressure should be strictly controlled immediately following the restoration of cerebral blood flow (CBF) by revascularization surgery. Despite intensive management, postoperative perfusion study has rarely demonstrated ipsilateral hyperperfusion.…”

Section: Introductionmentioning

confidence: 99%

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Stepwise Revascularization for Prevention of Postoperative Hyperperfusion

Yoshimoto¹,

Shirasaka²,

Yoshidumi³

et al. 2006

Neurol. Med. Chir.(Tokyo)

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Abrupt normalization of cerebral blood flow (CBF) after surgical procedures to improve excessive cerebral hypoperfusion can cause irreversible brain parenchymal damage. Such hyperperfusion, which is caused by inflow at normal blood pressure into maximally dilated fine vessels, is an important complication following carotid endarterectomy (CEA). Strict control of blood pressure in the perioperative period can prevent this complication except in a few patients, who have severe cerebral hypoperfusion and poor cerebrovascular reserve due to extremely severe stenosis of the ipsilateral or the bilateral carotid arteries, for which CEA is indicated. The requirement for improved CBF and the risk of postoperative hyperperfusion conflict in the pathogenesis of these patients. We tried to prevent abrupt improvement in perfusion by attempting gradual restoration of CBF. Superficial temporal arterymiddle cerebral artery anastomosis was first performed to improve the poor cerebrovascular reserve by allowing insufficient blood flow. A few weeks later, CEA was performed to completely restore CBF. This surgical approach obtained good results without postoperative problems in four patients. The indications of this surgical management and efficacy of stepwise restoration of CBF to prevent postoperative hyperperfusion depend on careful preoperative evaluation of perfusion studies.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Stepwise Revascularization for Prevention of Postoperative Hyperperfusion

Yoshimoto¹,

Shirasaka²,

Yoshidumi³

et al. 2006

Neurol. Med. Chir.(Tokyo)

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“…IMPSPECT) postoperatively is increased beyond that in the preoperative state [3] ; and, in cases of marked hypoperfusion, hyperperfusion after surgical revascularization is known to occur [4] . In this study, we aimed to evaluate the change of intracranial blood flow after carotid artery stenting (CAS) using the flow assessment application "FlowInsight," which was developed in our department; and to compare the results with those of IMP SPECT, which is currently commonly used in clinical practice [5] .…”

Section: Nisopropylp[123i] Iodoamphetaminesingle Photon Emission Compmentioning

confidence: 99%

“…Moreover, intraoperative measurement of distal internal carotid artery pressure reflects the intracranial vascular reserve, and is important in predicting postoperative hyperperfusion [4] . Reduced blood flow due to internal carotid artery stenosis results in decreased blood flow reserves intracranially, and this has been demonstrated to be significantly influenced by the microscopic vascular bed and the left and right or anterior and posterior communication [10] .…”

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confidence: 99%

Evaluation of changes of intracranial blood flow after carotid artery stenting using digital subtraction angiography flow assessment

Wada

Saito

Kamada

2015

WJR

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AIM:To evaluate the changes of intracranial blood flow after carotid artery stenting (CAS), using the flow assessment application "Flow-Insight", which was developed in our department. METHODS:Twenty patients treated by CAS participated in this study. We analyzed the change in concentration of the contrast media at the anterior-posterior and profile view image with the flow assessment application "Flow-Insight". And we compared the results with N-isopropyl-p-[123I] iodoamphetamine-single-photon emission computed tomography (IMP SPECT) performed before and after the treatment. RESULTS:From this study, 200% of the parameter "blood flow" change in the post/pre-treatment is suggested as the critical line of the hyperperfusion syndrome arise. Although the observed blood flow increase in the digital subtraction angiography system did not strongly correlate with the rate of increase of SPECT, the "Flow-Insight" reflected the rate of change of the vessels well. However, for patients with reduced reserve blood flow before CAS, a highly elevated site was in agreement with the site analysis results. CONCLUSION:We concluded that the cerebral angiography flow assessment application was able to more finely reveal hyperperfusion regions in the brain after CAS compared to SPECT. Core tip: Hyperperfusion syndrome is a relatively rare, but potentially serious, complication of carotid revascularization procedures. It is important to detect the excessive increase blood flow after treatment as soon as possible. We found that, although the observed blood flow increase in the digital subtraction ORIGINAL ARTICLE Basic Studyangiography system did not strongly correlate with the rate of increase of single-photon emission computed tomography before and after carotid artery stenting, the digital subtraction angiography flow assessment application more finely reflected the rate of change of the vessels well.Wada H, Saito M, Kamada K. Evaluation of changes of intracranial blood flow after carotid artery stenting using digital subtraction angiography flow assessment. World J Radiol 2015; 7(2): 45-51 Available from:

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“…Biztató eredményeket közöltek az arteria cerebri media (ACM) transcranialis Dopplerrel történő preoperatív áramlásmérése kapcsán [1,13,14]. Eszerint műtétet megelőzően az ACI poststenoticus szakaszának alacsony nyomása (<40 Hgmm) és a kirekesztés oldását követően a csúcssebesség 100%-ot meghaladó növekedése a CHS előrejelzője [1,13,14].…”

Section: ] (2 Táblázat)unclassified

Cerebralis hyperperfusiós szindróma és vérnyomáskontroll

et al. 2015

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Bevezetés: A cerebralis hyperperfusiós szindróma ritka, kevéssé ismert kórkép, amely azonban olykor súlyos következ-ményekkel járhat. Felléphet a carotis műtéti revascularisatióját vagy stentelését követően is. Jellegzetes tüneteinek felismerése (fejfájás, görcs, fokális neurológiai defi cit), a képalkotó vizsgálatok (ultrahang, komputertomográfi a) mielőbbi elvégzése döntő jelentőségű a kórismézés szempontjából. Célkitűzés: A nemzetközi irodalmat és a szerzők saját betegeinek adatait áttekintve a tünetegyüttes kialakulására nézve veszélyeztetett csoport kiszűrése, effektív terá-piás protokoll felállítása. Módszer: A szerzők osztályán kezelt betegek dokumentumait 2010-től napjainkig retrospektíve áttekintve, mindeddig 3 esetben találkoztak a kritériumoknak megfelelő fenti tünetegyüttessel. Eredmények: Mindhárom esetben hasonló elvek mentén, intenzív osztály közreműködésével avatkoztak közbe, azonban a közbe-lépés csak egy esetben volt hatékony, megfelelő terápiával gyors remisszió volt elérhető. Következtetések: Egyelőre, sajnos, nem áll rendelkezésre olyan diagnosztikai eszköz, amellyel hatékonyan és egyértelműen kiszűrhetők a kocká-zati csoportok, így megelőzési lehetőségként az egyetlen gyógyszeresen befolyásolható kockázati tényező, a vérnyo-más perioperatív beállítása marad kezünkben. Amennyiben a tünetek mégis kialakulnak, mielőbbi agresszív kezelés szükséges. Orv. Hetil., 2015, 156(26), 1049-1053.

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Evaluation of carotid distal pressure for prevention of hyperperfusion after carotid endarterectomy

Cited by 19 publications

References 9 publications

Stepwise Revascularization for Prevention of Postoperative Hyperperfusion

Stepwise Revascularization for Prevention of Postoperative Hyperperfusion

Evaluation of changes of intracranial blood flow after carotid artery stenting using digital subtraction angiography flow assessment

Cerebralis hyperperfusiós szindróma és vérnyomáskontroll

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