Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning

Abstract

Preoperative measurement of acetazolamide-induced changes in CBF, which is performed using SPECT scanning, can be used to identify patients at risk for hyperperfusion after CEA. In addition, post-CEA monitoring of CBF performed using SPECT scanning results in the timely and reliable identification of patients at risk for hyperperfusion syndrome.

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

“…Decreased vascular reserve on preoperative SPECT images has been reported as a predictor of hyperperfusion syndrome after CEA (Hosoda et al, 2001;Ogasawara et al, 2003). Cerebral perfusion pressure is generally considered to reflect cerebral vascular reserve and the CBF/CBV ratio is an index of cerebral perfusion pressure (Gibbs et al, 1984).…”

Preoperative Cerebral Oxygen Extraction Fraction Imaging Generated from 7T MR Quantitative Susceptibility Mapping Predicts Development of Cerebral Hyperperfusion following Carotid Endarterectomy

“…For each patient, post-CEA hyperperfusion was defined as a quantitative CBF increase of Ն100% (ie, doubling) compared with preoperative values in an MCA ROI ipsilateral to the side of surgery. 3,13 Pre-, Intra-, and Postoperative Management Antiplatelet therapy was given to all patients until the morning of the day of CEA, and surgery was performed with the patient under general anesthesia. 3 A heparin bolus (5000 IU) was administered before ICA clamping.…”

“…8 The risk factors for cerebral hyperperfusion include highgrade stenosis, poor collateral blood flow, contralateral carotid occlusion, and long-standing hypertension, and they often result in impaired cerebral hemodynamics. [11][12][13][14] When normal perfusion pressure is rapidly restored after CEA, hyperperfusion may occur in regions of the brain with impaired autoregulation due to chronic ischemia. This hypothesis is like the "normal perfusion pressure breakthrough" theory of Spetzler et al 13,15 Indeed, preoperative misery perfusion in the affected cerebral hemisphere is reportedly associated with the development of cerebral hyperperfusion following CEA or carotid stent placement for cervical ICA stenosis.…”

“…[11][12][13][14] When normal perfusion pressure is rapidly restored after CEA, hyperperfusion may occur in regions of the brain with impaired autoregulation due to chronic ischemia. This hypothesis is like the "normal perfusion pressure breakthrough" theory of Spetzler et al 13,15 Indeed, preoperative misery perfusion in the affected cerebral hemisphere is reportedly associated with the development of cerebral hyperperfusion following CEA or carotid stent placement for cervical ICA stenosis. 16,17 Misery perfusion is principally detected as an increased oxygen extraction fraction (OEF) on positron-emission tomography.…”

Changes in Cognitive Function After Carotid Endarterectomy in Older Patients: Comparison With Younger Patients

“…19) Based on the CBF values measured using brain perfusion SPECT, post-CEA hyperperfusion was defined as described previously. 19) Diffusionweighted magnetic resonance (MR) imaging was performed before and within 24 hours after surgery to identify new postoperative ischemic lesions.…”