Magnetic resonance imaging in patients with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy

Hirooka, Ryounoshin; Ogasawara, Kuniaki; Sasaki, Makoto; Yamadate, Keiko; Kobayashi, Masatoshi; Suga, Yasunori; Yoshida, Kenji; Otawara, Yasunari; Inoue, Takashi

doi:10.3171/jns/2008/108/6/1178

Cited by 54 publications

(27 citation statements)

References 26 publications

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“…5,7 However, MRI, including diffusion-and T2-weighted imaging, does not always demonstrate structural brain damage associated with postoperative cognitive impairment. 8 The distribution of central benzodiazepine receptors in the human brain has been widely studied with single-photon emission CT (SPECT) using 123 I-iomazenil (IMZ). 9 -12 Benzodiazepine receptor binding potential on 123 I-IMZ SPECT images correlates with brain neural density, and a reduction in cortical benzodiazepine receptor binding indicates cortical neural damage or loss.…”

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confidence: 99%

Postoperative Cortical Neural Loss Associated With Cerebral Hyperperfusion and Cognitive Impairment After Carotid Endarterectomy

Chida

Ogasawara

Suga

et al. 2009

Stroke

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Background and Purpose-Although cerebral hyperperfusion after carotid endarterectomy (CEA) often impairs cognitive function, MRI does not always demonstrate structural brain damage associated with postoperative cognitive impairment. The purpose of the present study was to determine whether postoperative cortical neural loss, which can be detected by 123 I-iomazenil single-photon emission CT, is associated with cerebral hyperperfusion after CEA and whether it correlates with postoperative cognitive impairment. Methods-In 60 patients undergoing CEA for ipsilateral internal carotid artery stenosis (Ͼ70%), cerebral blood flow was measured using N-isopropyl-p-[ 123 I]-iodoamphetamine single-photon emission CT before and immediately after CEA and on the third postoperative day. The distribution of benzodiazepine receptor binding potential in the cerebral cortex was assessed using 123 I-iomazenil single-photon emission CT before and 1 month after surgery and was analyzed using 3-dimensional stereotactic surface projection. Neuropsychological testing was also performed preoperatively and at the first postoperative month. Results-Post-CEA hyperperfusion and postoperative cognitive impairment were observed in 9 patients (15%) and 8 patients (13%), respectively. Post-CEA hyperperfusion was significantly associated with postoperative hemispheric reduction of benzodiazepine receptor binding potential (95%

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confidence: 99%

Postoperative Cortical Neural Loss Associated With Cerebral Hyperperfusion and Cognitive Impairment After Carotid Endarterectomy

Chida

Ogasawara

Suga

et al. 2009

Stroke

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“…Although perioperative cerebral blood flow was not measured, and cerebral hyperperfusion syndrome was not diagnosed in the present study, the results showed that the duration of ICA cross-clamping and extent of the carotid stenosis were significantly higher in patients with postoperative cognitive impairment than in those without. Development of cerebral hyperperfusion after CeA is associated with preoperative hemodynamic impairment (11), and the longer duration of ICA cross-clamping was independent predictor of postoperative hyperperfusion (17). It indicated the postoperative cognitive impairment in the patients who had more severe carotid artery stenosis and longer duration of ICA cross-clamping might also be related to postoperative hyperperfusion.…”

Section: █ Acknowledgmentmentioning

confidence: 88%

“…Hirooka et al (11) reported all the patients with cerebral hyperperfusion syndrome developed postoperative cognitive impairment. Although perioperative cerebral blood flow was not measured, and cerebral hyperperfusion syndrome was not diagnosed in the present study, the results showed that the duration of ICA cross-clamping and extent of the carotid stenosis were significantly higher in patients with postoperative cognitive impairment than in those without.…”

Section: █ Acknowledgmentmentioning

confidence: 99%

Cognitive function after carotid endarterectomy: early decline, and later recovery

Zhang

Ma²,

Chen³

et al. 2015

Turkish Neurosurgery

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(1,6,(8)(9)(10)19). Preoperative cognitive impairment, absence or variability of control group, various follow-up periods and influences of anesthesia contributed to obtain inconsistent results in the studies.We prospectively designed the following study to investigate neurocognitive performance following CeA in various followup periods, taking into account the potential factors described above. Our study aimed at investigating the potential role of procedure-related cerebral microembolism during CeA █ INTRODUCTION C hange of cognition is one of the threatening diseases. Cerebrovascular disease plays an important role in the development of dementia as reported by the strokedementia association (19). Carotid endarterectomy (CeA) provides a significant risk reduction for stroke (7,15), however, the effect of CeA on cognitive function is controversial. Many studies reported different findings including improvement, no change and deterioration of cognitive function following CeA AIm: To prospectively study neurocognitive performance following carotid endarterectomy (CeA) in various follow-up periods, taking into account the potential confounding factors. mATERIAl and mEThODS: Thirty-six patients with carotid artery stenosis received CeA (group A). Thirty-one patients underwent surgery for femoropopliteal occlusive disease served as controls (group B). Neuropsychological testing and brain magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) was repeated preoperatively, within 3 days and at 3 months after surgery. RESUlTS:No patient had DWI evidence of procedure-related cerebral ischemia. Preoperative baseline scores of groups A and B were not statistically different in mini mental state examination (MMSe) or clock drawing task (CDT) score. MMSe and CDT scores were significantly reduced for patients in group A (p<0.01) within 3 days after CEA. Differences of MMSE score (p=0.48) and CDT score (p=0.26) between baseline and 3 months after surgery in group A were not statistically significant. No statistically significant change of MMSe score and CDT score in group B was observed at 3 days and 3 months after the surgery. Degree of internal carotid artery (ICA) stenosis (p=0.029) and duration of ICA clamping (p=0.031) were significantly higher in patients with cognitive impairment immediately after CeA than in those without that. CONClUSION: Our study demonstrated cognitive decline for the patients with unilateral carotid stenosis at early stage after CeA and a restorative effect at 3 months after CeA. Postoperative early cognitive impairment might be associated with intraoperative temporary hypoperfusion and postoperative hyperperfusion, not the microembolic event.

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“…According to Hirooka et al (2008), cerebral hyperperfusion after CEA is defined as a 100% increase in CBF in PWI by MRI.…”

Section: Carotid Stenting Without Postdilatationmentioning

confidence: 99%

Decreased Cerebral Perfusion in Carotid Artery Stenosis, Carotid Angioplasty and Its Effects on Cerebral Circulation

Tavares¹,

Caldas²

2012

Advances in the Treatment of Ischemic Stroke

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Magnetic resonance imaging in patients with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy

Abstract: Although cerebral hyperperfusion syndrome after CEA sometimes results in reversible brain edema visible on MR imaging, postoperative cerebral hyperperfusion -- even when asymptomatic -- often results in impaired cognitive function without structural brain damage on MR imaging.

Cited by 54 publications

References 26 publications

Postoperative Cortical Neural Loss Associated With Cerebral Hyperperfusion and Cognitive Impairment After Carotid Endarterectomy

Postoperative Cortical Neural Loss Associated With Cerebral Hyperperfusion and Cognitive Impairment After Carotid Endarterectomy

Cognitive function after carotid endarterectomy: early decline, and later recovery

Decreased Cerebral Perfusion in Carotid Artery Stenosis, Carotid Angioplasty and Its Effects on Cerebral Circulation

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