Mechanisms of development of cerebral hyperperfusion following carotid endarterectomy and its influence on cerebral neuraltissue

颈动脉内膜剥脱术后脑过度灌注的发生机制及其对脑神经组织的影响

• 批准号: 18591603
• 负责人: OGASAWARA Kuniaki
• 金额: $ 2.52万
• 依托单位: Iwate Medical University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2006
• 资助国家: 日本
• 起止时间: 2006 至 2007
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-18591603/
• 关键词: (1)carotid endarterectomy; (2)cerebral bemodynamic impaurment; (3)erebral hyperperfusion; (4)reactive oxyeen species; 大脳皮質神経細胞損傷; 血行力学的脳虚血; フリーラジカル

Background and Purpose-The purpose of the present study was to determine whether preoperative cerebral hemodynamic impairment and reactive oxygen species produced during carotid endarterectomy (CEA) correlate with development of postoperative cerebral hyperperfusion. Methods-Concentrations of malondialdehyde-modified low-density lipoprotein (MDA-LDL), a biochemical marker of oxidative damage, were measured in serum samples obtained from 90 patients undergoing CEA for ipsilateral ICA stenosis (>70%). Serum samples were obtained from a venous catheter inserted into the ipsilateral jugular bulb before clamping of the internal carotid artery (ICA), 10 minutes after clamping of the ICA, and 5 and 20 minutes after declamping of the ICA. Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to acetazolamide were also measured using single-photon emission computed-tomography before CEA. In addition, CBF was measured postoperatively. Results-Hyperperfusion (CBF increase >100% compared with preoperative values) was observed immediately after CEA in 12 patients (13%). Logistic regression analysis demonstrated that reduced preoperative CVR (95% CIs, 1.053 to 1.453 ; P=0.0097) and an increase in MDA-LDL (calculated as a percentage of the preclamp values) after ICA declamping (95% CIs, 0.862 to 0.980 ; P=0.0098) were significantly associated with development ofpostoperative cerebral hyperperfusion among the variables tested. Ten of 11 patients with reduced preoperative CVR and increased MDA-LDL after ICA declamping developed post-CEA hyperperfusion, and 2 of these patients developed cerebral hyperperfusion syndrome. Conclusions-Both preoperative cerebral hemodynamic impairment and reactive oxygen species produced during surgery correlate with development of cerebral hyperperfusion after CEA.

背景和目的：本研究的目的是确定术前脑血流动力学损伤和颈动脉内膜切除术（CEA）过程中产生的活性氧是否与术后脑过度灌注的发展相关。方法：对90例接受CEA治疗的同侧ICA狭窄（bbb70 %）患者血清样本进行丙二醛修饰低密度脂蛋白（MDA-LDL）浓度测定，MDA-LDL是氧化损伤的生化标志物。在夹持颈内动脉（ICA）前、夹持颈内动脉10分钟后、夹持颈内动脉5分钟和去夹持颈内动脉20分钟后，将静脉导管置入同侧颈静脉球内，采集血清样本。CEA前用单光子发射计算机断层扫描测定脑血流量（CBF）和脑血管反应性（CVR）。此外，术后测量CBF。结果：12例（13%）CEA术后立即出现高灌注（CBF较术前增加100%）。Logistic回归分析显示，术前CVR降低（95% CIs, 1.053 ~ 1.453， P=0.0097）和ICA去钳后MDA-LDL升高（占钳前值的百分比）（95% CIs, 0.862 ~ 0.980， P=0.0098）与术后脑高灌注的发生显著相关。11例术前CVR降低、ICA去支后MDA-LDL升高的患者中，有10例出现cea后高灌注，其中2例出现脑高灌注综合征。结论：术前脑血流动力学损伤和术中产生的活性氧均与CEA后脑过度灌注的发生有关。

项目成果

Concentration of Matrix Metalloproteinase-9 in the Jugular Bulb During Carotid Endarterectomy Correlates with Secerity of Intraoperative Cerebral Ischemia

颈动脉内膜切除术期间颈静脉球中基质金属蛋白酶 9 的浓度与术中脑缺血的安全性相关

• 期刊: Cerebrovascular Diseases (In press)
• 作者: Ishigaki D;Ogasawara K;et. al.
• 通讯作者: et. al.

Postoperative cortical neural loss associated with cerebral hyperperfusion and cognitive impairment following carotid endarterectomy:1231-iomazenil SPECTstudy

颈动脉内膜切除术后与脑过度灌注和认知障碍相关的术后皮质神经损失：1231-iomazenil SPECT 研究

• 期刊: Stroke (In press)
• 作者: Chida K;Ogasawala K;et. al.
• 通讯作者: et. al.

Prediction of cerebral hyperperfusion after carotid endarterectomy using cerebral blood volume measured by perfusion-weighted MR imaging compared with single-photon emission CT.

• 发表时间: 2007-04
• 期刊: AJNR. American journal of neuroradiology
• 作者: T. Fukuda;K. Ogasawara;M. Kobayashi;Nobukazu Komoribayashi;H. Endo;Takashi Inoue;Y. Kuzu;H. Nishimoto;K. Terasaki;A. Ogawa

Prevalence, awareness and treatment of cardiovascular risk factors in patients at high risk of atherothrombosis in Japan - Results from domestic baseline data of the REduction of atherotherombosis for continued health (REACH) registry

• DOI: 10.1253/circj.71.995
• 发表时间: 2007-07-01
• 期刊: CIRCULATION JOURNAL
• 影响因子: 3.3
• 作者: Yamazaki, Tsutomu;Goto, Shinya;Ikeda, Yasuo
• 通讯作者: Ikeda, Yasuo

Reliability of cobalt-chromium alloy aneurysm clips after long-term impl antations in patients with cerebral aneurysms

钴铬合金动脉瘤夹长期植入脑动脉瘤患者后的可靠性

• 发表时间: 2006
• 期刊: Journal of Neurosurgery 105
• 作者: Kuniaki;O;Kashimura H.;Yamazaki T.;Ishigaki D.;Fukuda T.;Kenji Y;Kashimura H.;Ogawa a.;Ogawa a.;Suga Y.;Saito H.;Fujiwara S.;Ogasawara K.;Masanori K. et al.;Takaaki B. et al.;Hiroshi K. et al.;Ogasawara K.;Saito H.;Komoribayashi N.;Kashimura H.;Wada T.;Kuroda K.;Omama S.;久保 慶高;佐々木 真理;Otawara Y.
• 通讯作者: Otawara Y.