Transcranial Regional Cerebral Oxygen Saturation Monitoring during Carotid Endarterectomy as a Predictor of Postoperative Hyperperfusion

Ogasawara, Kuniaki; Konno, Hiromu; Yukawa, Hirotsugu; Endo, Hidehiko; Inoue, Takashi; Ogawa, Akira

doi:10.1227/01.neu.0000073547.86747.f3

Cited by 89 publications

(59 citation statements)

References 31 publications

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“…18,20 Moreover, intraoperative transcranial regional cerebral oxygen saturation is another essential indicator for post-CEA hyperperfusion syndrome. 21 Ascher et al demonstrated that contralateral CEA within 3 months was associated with post-CEA hyperperfusion syndrome; 22 1 of 6 patients with bilateral CEA had the syndrome in this study.…”

Section: Discussionsupporting

confidence: 54%

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

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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.

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Section: Discussionsupporting

confidence: 54%

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

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“…Ogasawara et al [13] compared declamping rSO 2 with preclamping values and found a significant correlation between rSO 2 increases after declamping and the onset of CHS. However, in their study, only 1 patient developed CHS.…”

Section: Discussionmentioning

confidence: 99%

Near-Infrared Spectroscopy Can Predict the Onset of Cerebral Hyperperfusion Syndrome after Carotid Endarterectomy

Pennekamp¹,

Immink²,

Ruijter

et al. 2012

Cerebrovasc Dis

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Background: Cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy (CEA) is a potential life-threatening complication. Therefore, early identification and treatment of patients at risk is essential. CHS can be predicted by a doubling of postoperative transcranial Doppler (TCD)-derived mean middle cerebral artery blood velocity (V_mean) compared to preoperative values. However, in approximately 15% of CEA patients, an adequate TCD signal cannot be obtained due to an insufficient temporal bone window. Moreover, the use of TCD requires specifically skilled personnel. An alternative and promising technique of noninvasive cerebral monitoring is relative frontal lobe oxygenation (rSO₂) measured by near-infrared spectroscopy (NIRS), which offers on-line information about cerebral oxygenation without the need for specialized personnel. In this study, we assess whether NIRS and perioperative TCD are related to the onset CHS following CEA. Methods: Patients who underwent CEA under general anesthesia and had a sufficient TCD window were prospectively included. The V_mean and rSO₂ measured before induction of anesthesia were compared to measurements performed in the first postoperative hour (ΔV_mean, ΔrSO₂, respectively). Logistic regression analysis was performed to determine the relationship between ΔV and ΔrSO₂ and the occurrence of CHS. Subsequently, receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff values. Diagnostic values were shown as positive and negative predictive values (PPV and NPV). Results: In total, 151 patients were included, of which 7 patients developed CHS. The ΔV_mean and ΔrSO₂ differed between CHS and non-CHS patients (median, interquartile range), i.e. 74% (67–103) versus 16% (–2 to 41), p = 0.001, and 7% (4–15) versus 1% (–6 to 7), p = 0.009, respectively. The mean arterial blood pressure did not change. Postoperative ΔV_mean and ΔrSO₂ were significantly related to the occurrence of CHS [odds ratio (OR) 1.40 (95% CI 1.02–1.93) per 30% increase in V_mean and OR 1.82 (95% CI 1.11–2.99) per 5% increase in rSO₂]. ROC curve analysis showed an area under the curve of 0.88 (p = 0.001) for ΔV_mean and an optimal cutoff value of 67% increase (PPV 38% and NPV 99%), and an area under the curve of 0.79 (p = 0.009) for ΔrSO₂ and an optimal cutoff value of 3% rSO₂ increase (PPV 11% and NPV 100%). The combination of both monitoring techniques provided a PPV of 58% and an NPV of 99%. Conclusions: Both TCD and NIRS measurements can be used to safely identify patients not at risk of developing CHS. It appears that NIRS is a good alternative when a TCD signal cannot be obtained.

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“…Positron emission tomography (PET) can be considered the gold standard for determining oxygen extraction fraction (OEF; the amount of oxygen extracted from the blood) and has been widely used to study brain oxygenation in a variety of conditions. [1][2][3][4][5][6][7] However, in the setting of acute stroke management, PET is not a reasonable option for most centers. Near-infrared spectroscopy (NIRS) is a noninvasive and low-cost technique that can measure oxyhemoglobin (HbO 2 ) and deoxyhemoglobin concentrations (HHb) at bedside.…”

Section: Introductionmentioning

confidence: 99%

Near-infrared measurements of brain oxygenation in stroke

et al. 2016

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Abstract. We investigated the feasibility of using frequency-domain near-infrared spectroscopy (fdNIRS) to study brain oxygenation in the first few hours of stroke onset. The OxiplexTS ® fdNIRS system was used in this study. Using a standard probing protocol based on surface landmarks, we measured brain tHb and S t O 2 in healthy volunteers, cadavers, and acute stroke patients within 9 h of stroke onset and 3 days later. We obtained measurements from 11 controls, 5 cadavers, and 5 acute stroke patients. S t O 2 values were significantly lower in cadavers compared to the controls and stroke patients. Each stroke patient had at least one area with reduced S t O 2 on the stroke side compared to the contralateral side. The evolution of tHb and S t O 2 at 3 days differed depending on whether a large infarct occurred. This study shows the proof of principle that quantified measurements of brain oxygenation using NIRS could be used in the hectic environment of acute stroke management. It also highlights the current technical limitations and future challenges in the development of this unique bedside monitoring tool for stroke.

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Transcranial Regional Cerebral Oxygen Saturation Monitoring during Carotid Endarterectomy as a Predictor of Postoperative Hyperperfusion

Abstract: Intraoperative rSO(2) monitoring can reliably identify patients at risk for hyperperfusion after CEA.

Cited by 89 publications

References 31 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

Near-Infrared Spectroscopy Can Predict the Onset of Cerebral Hyperperfusion Syndrome after Carotid Endarterectomy

Near-infrared measurements of brain oxygenation in stroke

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