Post-carotid endarterectomy hyperperfusion syndrome: Preliminary observations for identifying at risk patients by transcranial doppler sonography and the acetazolamide test

Sbarigia, Enrico; Speziale, Francesco; Giannoni, Maria Fabrizia; Colonna, M.; Panico, Maria; Fiorani, P

doi:10.1016/s0950-821x(05)80005-2

Cited by 72 publications

(47 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently, it has been demonstrated that transcranial Doppler ultrasonography (TCD) with acetazolamide challenge is also able to assess cerebral vasoreactivity. 33,34 However, TCD cannot measure CBF itself, in contrast to SPECT.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Vasoreactivity and Internal Carotid Artery Flow Help to Identify Patients at Risk for Hyperperfusion After Carotid Endarterectomy

Hosoda

Kawaguchi

Shibata

et al. 2001

Stroke

170

127

View full text Add to dashboard Cite

Background and Purpose-Hyperperfusion syndrome is a rare but potentially devastating complication after carotid endarterectomy (CEA). The aim of this study was to investigate whether preoperative measurement of cerebral vasoreactivity (CVR) and intraoperative measurement of internal carotid artery (ICA) flow could identify patients at risk for hyperperfusion after CEA. Methods-For 26 patients with unilateral ICA stenosis Ն70%, cerebral blood flow (CBF) and CVR were investigated before and 1 month after CEA, with resting and acetazolamide-challenge single-photon emission CT. CBF on the first postoperative day was also measured. ICA flow was measured before and after reconstruction by electromagnetic flowmeter during surgery. Results-Ipsilateral CBF on the first postoperative day significantly increased relatively (56.6Ϯ53.2%) as well as absolutely (37.9Ϯ8.8 to 57.7Ϯ18.0 mL/100 g per minute) in the reduced CVR group (CVR Ͻ12%) but not in the normal CVR group (CVR Ն12%) (10.3Ϯ15.5% and 40.6Ϯ7.9 to 43.9Ϯ5.7 mL/100 g per minute, respectively). One month later, this difference almost disappeared. Two patients showed ipsilateral CBF increase of Ն100%. A significant association of intracerebral steal with hyperperfusion (CBF increase Ն100%) on the first postoperative day was also observed. ICA flow increase after reconstruction significantly correlated with CBF increase on the first postoperative day in the reduced CVR group but not in the normal CVR group. The threshold of ICA flow increase for hyperperfusion was estimated to be 330 mL/min in the reduced CVR group. Conclusions-Single-photon emission CT with acetazolamide challenge and ICA flow measurement during surgery could identify patients at risk for hyperperfusion after CEA, in whom careful monitoring and control of blood pressure should be initiated even intraoperatively. (Stroke. 2001;32:1567-1573.)

show abstract

Section: Discussionmentioning

confidence: 99%

Cerebral Vasoreactivity and Internal Carotid Artery Flow Help to Identify Patients at Risk for Hyperperfusion After Carotid Endarterectomy

Hosoda

Kawaguchi

Shibata

et al. 2001

Stroke

170

127

View full text Add to dashboard Cite

show abstract

“…Hyperperfusion is known to occur after carotid endarterectomy, extracranial-intracranial bypass surgery, and percutaneous transluminal angioplasty. 2,[7][8][9] Here we describe a case of hyperperfusion syndrome after clipping of an unruptured small aneurysm.…”

Section: Introductionmentioning

confidence: 94%

Hyperperfusion Syndrome After Clipping of an Unruptured Aneurysm-Case Report-

Kuroki

Taguchi

Yukawa

2006

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

A 41-year-old man developed hyperperfusion 24 hours after undergoing successful clipping surgery for an unruptured middle cerebral artery aneurysm with temporary occlusion for 7 minutes. The patient exhibited motor aphasia 24 hours after surgery. Single photon emission computed tomography revealed hyperperfusion. The patient was sedated for 72 hours using propofol, and his symptoms gradually resolved. He returned to his previous job 2 months after surgery. Hyperperfusion syndrome is possible following any aneurysm surgery, including surgery for unruptured aneurysms using the temporary occlusion technique.

show abstract

“…3,8,10,11) Hyperperfusion syndrome is defined as cerebral blood flow (CBF) in excess of the flow required for metabolic needs, and is characterized by the diagnostic triad of unilateral headache, seizures, and intracranial hemorrhage. 5) Hyperperfusion syndrome has also been reported following surgery for giant aneurysms after temporary clipping 6) and for subarachnoid hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Hyperperfusion Syndrome After Clipping an Unruptured Cerebral Aneurysm -Two Case Reports-

Sugino

Ohtaki

Wanibuchi

et al. 2010

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

A 68-year-old woman presented with severe headache 9 days after undergoing successful clipping of a right middle cerebral artery aneurysm. Postoperative imaging revealed increased perfusion and diffuse edema in the right frontotemporal cortex. A 57-year-old woman exhibited perseveration soon after undergoing successful clipping of an anterior communicating artery aneurysm. Postoperative imaging studies revealed increased perfusion and diffuse edema in the left frontal and insular cortex. The symptoms and diffuse edema gradually resolved in both patients. These two cases of hyperperfusion syndrome occurred in a series of 190 patients treated by clipping of unruptured cerebral aneurysms. Hyperperfusion syndrome is a rare complication following aneurysm surgery, especially surgery for unruptured cerebral aneurysms without temporary clipping.

show abstract

Post-carotid endarterectomy hyperperfusion syndrome: Preliminary observations for identifying at risk patients by transcranial doppler sonography and the acetazolamide test

Cited by 72 publications

References 20 publications

Cerebral Vasoreactivity and Internal Carotid Artery Flow Help to Identify Patients at Risk for Hyperperfusion After Carotid Endarterectomy

Cerebral Vasoreactivity and Internal Carotid Artery Flow Help to Identify Patients at Risk for Hyperperfusion After Carotid Endarterectomy

Hyperperfusion Syndrome After Clipping of an Unruptured Aneurysm-Case Report-

Hyperperfusion Syndrome After Clipping an Unruptured Cerebral Aneurysm -Two Case Reports-

Contact Info

Product

Resources

About