Three Cases of Hyperperfusion Syndrome Identified by Daily Transcranial Doppler Investigation After Carotid Surgery

Schaafsma, A.; Veen, L. van; Vos, Jacobus Cornelis de

doi:10.1053/ejvs.2001.1545

Cited by 28 publications

(14 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In previous studies using TCD, the diagnostic criterion of hyperperfusion syndrome was mostly a Ն2-fold increase in MCA peak systolic or MFV after CEA. 3,4,6 In this study, an MFV ratio of Ն1.5 within 4 postsurgical days yielded a sensitivity of 100% and a specificity of 84%. An MFV ratio of Ն1.4 the next morning after CEA was another indicator that predicted hyperperfusion syndrome perfectly, although its specificity was relatively low (67%).…”

Section: Discussionmentioning

confidence: 50%

“…[3][4][5][6] However, because of questions regarding accuracy of TCD in diagnosing hyperperfusion syndrome, some controversy remained. Because precise placement of the sample volume as well as angle correlation is not possible by means of the TCD technique, TCD cannot determine absolute MCA flow velocity values.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] However, the accuracy of TCD for measuring MCA flow velocity remained controversial. One can more readily and confidently identify particular vascular structure with transcranial color-coded real-time sonography (TCCS) than with TCD.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Fujimoto

Toyoda

Inoue

et al. 2004

Stroke

View full text Add to dashboard Cite

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 (rϭ0.48; PϽ0.0001). An increase of Ͼ50% 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. (Stroke.

show abstract

Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Fujimoto

Toyoda

Inoue

et al. 2004

Stroke

View full text Add to dashboard Cite

show abstract

“…First, in acute hypertensive encephalopathy, there is failure of autoregulatory vasoconstriction with dilation of distal vessels and increased cerebral blood flow (30); fibrinoid necrosis of arterioles leads to cerebral microinfarcts and petechial hemorrhages (3). Second, the cerebral hyperperfusion syndrome may follow cerebral revascularisation by endarterectomy (24) or stent placement (19); newly elevated perfusion pressure overwhelms arteriolar autoregulation, sometimes precipitating intracerebral hemorrhage. Finally, a breakdown of cerebral autoregulation with hyperperfusion may lead to vasogenic cerebral edema in the preeclampsia/eclampsia syndrome (33).…”

Section: Discussionmentioning

confidence: 99%

Cerebral artery responses to pressure and flow in uremic hypertensive and spontaneously hypertensive rats

New

Chesser

Thuraisingham

et al. 2003

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

New, D. I., A. M. S. Chesser, R. C. Thuraisingham, and M. M. Yaqoob. Cerebral artery responses to pressure and flow in uremic hypertensive and spontaneously hypertensive rats. Am J Physiol Heart Circ Physiol 284: H1212-H1216, 2003; 10.1152/ajpheart.00644.2002.-Impaired cerebral blood flow autoregulation is seen in uremic hypertension, whereas in nonuremic hypertension autoregulation is shifted toward higher perfusion pressure. The cerebral artery constricts in response to a rise in either lumen pressure or flow; we examined these responses in isolated middle cerebral artery segments from uremic Wistar-Kyoto rats (WKYU), normotensive control rats (WKYC), and spontaneously hypertensive rats (SHR). Pressure-induced (myogenic) constriction developed at 100 mmHg; lumen flow was then increased in steps from 0 to 98 l/min. Some vessels were studied after endothelium ablation. Myogenic constriction was significantly lower in WKYU (28 Ϯ 2.9%) compared with both WKYC (39 Ϯ 2.5%, P ϭ 0.035) and SHR (40 Ϯ 3.1%, P ϭ 0.018). Flow caused constriction of arteries from all groups in an endothelium-independent manner. The response to flow was similar in WKYU and WKYC, whereas SHR displayed increased constriction compared with WKYU (P Ͻ 0.001) and WKYC (P Ͻ 0.001). We conclude that cerebral myogenic constriction is decreased in WKYU, whereas flow-induced constriction is enhanced in SHR. myogenic tone; flow-induced constriction; myograph UREMIA IS ASSOCIATED WITH STROKE, particularly hemorrhagic stroke, in animals (25) and humans (10). Although raised blood pressure often contributes to this risk (11,15), other factors may be important. In the stroke-prone hypertensive rat, uremia develops due to hypertensive glomerulosclerosis (9), followed by impaired cerebral autoregulation, before stroke (26, 28). Humans with renal failure have increased cerebral blood flow with decreased vasodilatory capacity (16). Therefore, it is possible that an abnormality of cerebral vascular autoregulation, characterized by inadequate constriction, results from uremia.Conversely, hypertensive (nonuremic) animals (1, 21) and humans (17,29) show vascular adaptation with a shift of cerebral blood flow autoregulation toward higher levels of arterial pressure. The increased vascular resistance is largely due to greater constriction, rather than to smooth muscle hypertrophy (23), and maintains constancy of blood flow despite systemic hypertension.Cerebral vascular resistance is to a major extent determined by the degree of contraction of larger proximal arteries such as the middle cerebral artery (7), unlike other vascular beds, in which most of the resistance to blood flow occurs in arteries below ϳ200 m diameter (4, 20). Large artery tone therefore regulates cerebral microvascular pressure (1, 7), and it has been suggested that this mechanism protects more distal thin-walled intracranial blood vessels (8). If this is the case, then enhanced proximal cerebral vascular resistance may guard against stroke in chronic nonuremic hypertension, whereas inadequate va...

show abstract

“…Schaafsma et al (2002) suggested that a blood-flow velocity level of the postoperative ipsilateral middle cerebral artery exceeding the preoperative level by 100% would be an early and sensitive indicator of the occurrence of hyperperfusion syndrome. Thirteen patients in this study showed perioperative transition perfusion, and they all had a high stenosis situation.…”

Section: Discussionmentioning

confidence: 99%

Clinical effects and safety review of self-expanding stent surgery for extracranial carotid artery stenosis treatment

Zhu¹,

Fang²,

Wang³

et al. 2014

Genet. Mol. Res.

View full text Add to dashboard Cite

ABSTRACT. This study aimed to investigate the clinical effects and safety review of self-expanding stent surgery in the treatment of extracranial carotid artery stenosis. Seventy-eight patients with carotid artery stenosis were applied with the self-expanding stent for endovascular interventional therapy. Eighty-one stents were implanted into 80 blood vessels of the 78 patients, in which protective umbrellas were used in 56 cases, and the success rate of stent implantation was 100%. The stenosis degree decreased from the preoperative (86.72 ± 9.5%) to the postoperative (13.43 ± 5.62%) stage, and the blood peak velocity of the stenosed vessels decreased from 189.58 ± 13.5 to 83.73 ± 5.61 cm/s. Transient blood pressure and heart rate decreases occurred in 21 cases, continuously low blood pressure and heart rate decreasing occurred in 29 cases, and acute occlusion of the ipsilateral middle cerebral artery occurred in 1 case, which was resolved through thrombolysis and thrombus breaking in time. Overperfusion symptoms were observed in 13 cases, although without serious complications such as cerebral hemorrhage. The follow-up period continued for 6-32 months, and ultrasonography revealed that Evaluation of self-expanding stent surgery 77 cases had no stent-restenosis, while 1 case had restenosis. The application of self-expanding stents had good clinical effects, with fewer complications and higher safety for the treatment of extracranial carotid artery stenosis.

show abstract

Three Cases of Hyperperfusion Syndrome Identified by Daily Transcranial Doppler Investigation After Carotid Surgery

Abstract: daily TCD investigation in all patients undergoing CEA seems an effective strategy for the presymptomatic detection of HS.

Cited by 28 publications

References 16 publications

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

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

Cerebral artery responses to pressure and flow in uremic hypertensive and spontaneously hypertensive rats

Clinical effects and safety review of self-expanding stent surgery for extracranial carotid artery stenosis treatment

Contact Info

Product

Resources

About