Preoperative cerebrovascular reactivity to acetazolamide measured by brain perfusion SPECT predicts development of cerebral ischemic lesions caused by microemboli during carotid endarterectomy

Aso, Kenta; Ogasawara, Kuniaki; Sasaki, Makoto; Kobayashi, Masatoshi; Suga, Yasunori; Chida, Kohei; Otawara, Yasunari; Ogawa, Akira

doi:10.1007/s00259-008-0886-y

Cited by 43 publications

(30 citation statements)

References 29 publications

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“…Variables with a P value of less than 0.2 in the univariate analyses were selected for analysis in the final model. However, preoperative CVR in the affected hemisphere was not adopted in the model because previous studies have already established the strong relationship between this factor and the development of new postoperative cerebral ischemic events or post-CEA hyperperfusion (19,20,(22)(23)(24). Differences were deemed statistically significant if the P value was less than 0.05.…”

Section: Discussionmentioning

confidence: 99%

“…According to the concept proposed by Caplan and Hennerici (40), preexisting hemodynamic impairment may facilitate the onset of ischemia due to emboli generated from a proximal lesion. One study has demonstrated that reduction of preoperative cerebrovascular reactivity to acetazolamide measured by brain perfusion SPECT predicts the development of new postoperative cerebral ischemic lesions on DWI that are caused by microemboli generated during carotid dissection in CEA (20).…”

Section: Discussionmentioning

confidence: 99%

“…For CVR in the MCA ROI in the cerebral hemisphere ipsilateral to CEA, data described previously (36.8% 6 9.2%) (20) were used as control values.…”

Section: Brain Spect Studymentioning

confidence: 99%

“…Risk factors for the development of cerebrovascular complications associated with CEA include preoperative impairments in cerebral hemodynamics (19)(20)(21)(22)(23)(24). Several investigators have demonstrated that a decrease in cerebrovascular reactivity (CVR) to acetazolamide, as measured using SPECT, predicts postoperative new cerebral ischemic events due to hemispheric hypoperfusion during ICA clamping (19) or emboli from the surgical site (20), or post-CEA hyperperfusion (22)(23)(24).…”

mentioning

confidence: 99%

“…Several investigators have demonstrated that a decrease in cerebrovascular reactivity (CVR) to acetazolamide, as measured using SPECT, predicts postoperative new cerebral ischemic events due to hemispheric hypoperfusion during ICA clamping (19) or emboli from the surgical site (20), or post-CEA hyperperfusion (22)(23)(24). However, acetazolamide is associated with frequent and various adverse side effects, including metabolic acidosis, hypokalemia, numbness of the extremities, headache, tinnitus, gastrointestinal disturbances, and Stevens-Johnson syndrome (25,26).…”

mentioning

confidence: 99%

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Preoperative Central Benzodiazepine Receptor Binding Potential and Cerebral Blood Flow Images on SPECT Predict Development of New Cerebral Ischemic Events and Cerebral Hyperperfusion After Carotid Endarterectomy

et al. 2011

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Risk factors for cerebrovascular complications developing during or after carotid endarterectomy (CEA) include preoperative impairments in cerebral hemodynamics, as detected by the demonstration of decreased cerebrovascular reactivity (CVR) to acetazolamide on brain perfusion SPECT. Central benzodiazepine receptor binding potential (CBRBP) and cerebral blood flow (CBF) images on SPECT provide high sensitivity and high specificity for detecting misery perfusion in patients with chronic unilateral major cerebral artery occlusive disease. The aim of the present study was to determine whether preoperative CBRBP/CBF images on SPECT could identify patients at risk for new cerebral ischemic events, including neurologic deficits and cerebral ischemic lesions on diffusionweighted MRI, or cerebral hyperperfusion after CEA and to compare the predictive accuracy of CBRBP/CBF with that of CVR to acetazolamide on SPECT. Methods: CBF, CVR, and CBRBP were assessed using N-isopropyl-p-123 I-iodoamphetamine ( 123 I-IMP) and 123 I-iomazenil SPECT before CEA in 112 patients with unilateral internal carotid artery stenosis ($70%). CBF measurement using 123 I-IMP SPECT was also performed immediately and 3 d after CEA. A region of interest was automatically placed in the middle cerebral artery territory in both cerebral hemispheres using a 3-dimensional stereotactic region-of-interest template. Diffusion-weighted MRI was performed within 3 d before and 24 h after surgery. Results: A preoperative increase in the affected side-to-contralateral side asymmetry on CBRBP/CBF value was the only significant independent predictor of postoperative new cerebral ischemic events (95% confidence intervals [CI], 1.145-1.608; P 5 0.0004) or post-CEA hyperperfusion (95% CI, 1.244-2.252; P 5 0.0007). There was no difference in the ability to predict post-CEA hyperperfusion when comparing the area under the receiver-operating-characteristic curve of the affected side-tocontralateral side asymmetry on CBRBP/CBF and that of the CVR in the affected hemisphere. However, the former value (0.924; 95% CI, 0.854-0.972) was significantly greater than the latter value (0.782; 95% CI, 0.697-0.852) for the prediction of new postoperative cerebral ischemic events (P , 0.05). Conclusion: Preoperative CBRBP/CBF images on SPECT can more accurately identify patients at risk for cerebrovascular complications occurring during or after CEA when compared with preoperative CVR to acetazolamide.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…For CVR in the MCA ROI in the cerebral hemisphere ipsilateral to CEA, data described previously (36.8% 6 9.2%) (20) were used as control values.…”

Section: Brain Spect Studymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Preoperative Central Benzodiazepine Receptor Binding Potential and Cerebral Blood Flow Images on SPECT Predict Development of New Cerebral Ischemic Events and Cerebral Hyperperfusion After Carotid Endarterectomy

et al. 2011

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EANM procedure guideline for brain perfusion SPECT using 99mTc-labelled radiopharmaceuticals, version 2

Kapucu

Nobili

Varrone

et al. 2009

Eur J Nucl Med Mol Imaging

150

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These guidelines summarize the current views of the European Association of Nuclear Medicine Neuroimaging Committee (ENC). The purpose of the guidelines is to assist nuclear medicine practitioners when making recommendations, performing, interpreting, and reporting the results of brain perfusion single photon emission computed tomography (SPECT) studies using (99m)Tc-labelled radiopharmaceuticals. The aim is to achieve a high quality standard for brain perfusion SPECT imaging, which will increase the diagnostic impact of this technique in clinical practice. The present document replaces a former version of the guideline published in 2001 which was inspired by the Society of Nuclear Medicine Procedure Guideline for Brain Perfusion SPECT [1], the views of the Society of Nuclear Medicine Brain Imaging Council [2], and the individual experience of experts in European countries. The guidelines are intended to present information specifically adapted to European practice. The information provided should be taken in the context of local conditions and regulations.

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Assessment of cerebrovascular reactivity using real-time BOLD fMRI in children with moyamoya disease: a pilot study

2012

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Preoperative cerebrovascular reactivity to acetazolamide measured by brain perfusion SPECT predicts development of cerebral ischemic lesions caused by microemboli during carotid endarterectomy

Abstract: Preoperative CVR to acetazolamide measured by quantitative brain perfusion SPECT predicts development of cerebral ischemic lesions on postoperative DWI that are caused by microemboli during CEA.

Cited by 43 publications

References 29 publications

Preoperative Central Benzodiazepine Receptor Binding Potential and Cerebral Blood Flow Images on SPECT Predict Development of New Cerebral Ischemic Events and Cerebral Hyperperfusion After Carotid Endarterectomy

Preoperative Central Benzodiazepine Receptor Binding Potential and Cerebral Blood Flow Images on SPECT Predict Development of New Cerebral Ischemic Events and Cerebral Hyperperfusion After Carotid Endarterectomy

EANM procedure guideline for brain perfusion SPECT using 99mTc-labelled radiopharmaceuticals, version 2

Assessment of cerebrovascular reactivity using real-time BOLD fMRI in children with moyamoya disease: a pilot study

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