Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning
Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning
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DOI：
10.3171/jns.2003.99.3.0504
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发表时间：
2003-09-01
影响因子：
4.1
通讯作者：
Ogawa, A
中科院分区：
文献类型：
--
作者：
Ogasawara, K;Yukawa, H;Ogawa, A
物体。本研究的目的是确定是否可以使用单光子发射计算机断层扫描(SPECT)在术前测量乙酰唑胺引起的脑血流量(CBF)变化，以确定颈动脉内膜切除术(CEA)后有高灌注风险的患者。此外，作者还调查了CEA术后SPECT脑血流监测是否可以用于识别有高灌注综合征风险的患者。对51例同侧颈内动脉狭窄(狭窄程度大于或等于70%)患者在CEA前测定脑血流量和脑血管反应性(CVR)。CEA后即刻和术后第3天测量脑血流量。12例术前CVR降低的患者中有8例在CEA后即刻观察到高血流灌注(CBF较术前增加100%或以上)。术前CVR减少是CEA术后高灌注的唯一显著独立预测因素。43例CEA术后即刻未发现高灌注者，术后第3天未出现高灌注者，未出现高灌注症。在CEA术后立即发生高灌注的8名患者中，有2名患者的脑血流量进行性增加，并出现了高灌注综合征，但没有发生脑出血。在CEA术后即刻检测到高灌注的8名患者中，其余6名患者的CBF进行性下降，术后第3天高灌注区消失。术前测量乙酰唑胺引起的脑血流变化，使用SPECT扫描，可以用来识别CEA术后有高灌注风险的患者。此外，CEA术后使用SPECT扫描对脑血流进行监测，可以及时、可靠地识别有高灌流综合征风险的患者。
Object. The purpose of this study was to determine whether the preoperative measurement of acetazolamide-induced changes in cerebral blood flow (CBF), which is performed using single-photon emission computerized tomography (SPECT) scanning, can be used to identify patients at risk for hyperperfusion following carotid endarterectomy (CEA). In addition, the authors investigated whether monitoring of CBF with SPECT scanning after CEA can be used to identify patients at risk for hyperperfusion syndrome.Methods. Cerebral blood flow and cerebrovascular reactivity (CVR) to acetazolamide, were measured before CEA in 51 patients with ipsilateral internal carotid artery stenosis (greater than or equal to 70% stenosis). Cerebral blood flow was also measured immediately after CEA and on the 3rd postoperative day.Hyperperfusion (an increase in CBF of greater than or equal to 100% compared with preoperative values) was observed immediately after CEA in eight of 12 patients with reduced preoperative CVR. Reduced preoperative CVR was the only significant independent predictor of post-CEA hyperperfusion. Forty-three patients in whom hyperperfusion was not detected immediately after CEA did not exhibit hyperperfusion on the 3rd postoperative day and did not experience hyperperfusion syndrome. In two of eight patients in whom hyperperfusion occurred immediately after CEA, CBF progressively increased and hyperperfusion syndrome developed, but intracerebral hemorrhage did not occur. In the remaining six of eight patients in whom hyperperfusion was detected immediately after CEA, the CBF progressively decreased and the hyperperfusion resolved by the 3rd postoperative day.Conclusions. 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.