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57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

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Cerebral hyperperfusion after carotid endarterectomy is associated with preoperative hemodynamic impairment and intraoperative cerebral ischemia

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  • corresponding author N. Komoribayashi - Department of Neurosurgery, School of Medicine, Iwate Medical University
  • K. Ogasawara - Department of Neurosurgery, School of Medicine, Iwate Medical University
  • T. Inoue - Department of Neurosurgery, School of Medicine, Iwate Medical University
  • M. Kobayashi - Department of Neurosurgery, School of Medicine, Iwate Medical University
  • A. Ogawa - Department of Neurosurgery, School of Medicine, Iwate Medical University

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.05.07

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc031.shtml

Veröffentlicht: 8. Mai 2006

© 2006 Komoribayashi et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.

Gliederung

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Objective: The aim of this study was to investigate whether postoperative hyperperfusion is associated with preoperative cerebral hemodynamic impairment due to chronic ischemia and with acute cerebral ischemia during clamping of the internal carotid artery (ICA) during carotid endarterectomy (CEA).

Methods: Transcranial cerebral oxygen saturation (SO2) was monitored intraoperatively using near-infrared spectroscopy in 89 patients undergoing CEA for ipsilateral ICA stenosis (>70%). Cerebral blood flow (CBF) and cerebrovascular reserve capacity (CVRC) to acetazolamide were also measured using single-photon emission computed-tomography (SPECT) before CEA. In addition, CBF was measured immediately after CEA and on the third postoperative day.

Results: Hyperperfusion (CBF increase >100% compared with preoperative values) was observed immediately after CEA in 10 of 18 patients (56%) with reduced preoperative CVRC. Also, post-CEA hyperperfusion was observed in 9 of 16 patients (56%) whose SO2 during clamping of the ICA decreased to less than 90% of the pre-clamping value. Logistic regression analysis demonstrated that reduced preoperative CVRC and reduced SO2 during ICA clamping were significant independent predictors of the development of hyperperfusion immediately after CEA. In fact, all patients with reduced preoperative CVRC and reduced SO2 during ICA clamping developed post-CEA hyperperfusion, and two of these patients developed cerebral hyperperfusion syndrome.

Conclusions: Development of cerebral hyperperfusion after CEA is associated with preoperative hemodynamic impairment and intraoperative cerebral ischemia.