Preoperatively reduced cerebrovascular contractile reactivity to hypocapnia by hyperventilation is associated with cerebral hyperperfusion syndrome after arterial bypass surgery for adult patients with cerebral misery perfusion due to ischemic moyamoya disease

Sato, Shinpei; Kojima, Daigo; Shimada, Yasushi; Yoshida, Jun; Fujimato, Kentaro; Fujiwara, Shunrou; Kobayashi, Masatoshi; Kubo, Yoshitaka; Yoshida, Kenji; Terasaki, Kazunori; Tsutsui, Shouta; Miyoshi, Kenya; Ogasawara, Kuniaki

doi:10.1177/0271678x18757621

Cited by 30 publications

(34 citation statements)

References 30 publications

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“…TTP value on a PWI map also verified the improvement of perfusion after RIC, as TTP was always regarded as the preclinical sensitive indicator . RIC may promote the autoregulatory vasodilation and increase oxygen extraction fraction in humans to reduce stroke recurrence rate in chronic cerebral circulation insufficiency . In addition, collateral compensation may contribute to the perfusion improvement, despite with poor evidences of the mechanisms in this study .…”

Section: Discussionsupporting

confidence: 54%

Remote ischemic conditioning for the treatment of ischemic moyamoya disease

et al. 2019

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Aims This study investigated the safety and efficacy of remote ischemic conditioning (RIC) on ameliorating the sequelae of ischemic moyamoya disease (iMMD). Methods A total of 30 iMMD patients underwent long‐term RIC and were followed up at 0.5, 1, and 2 years for clinical outcomes, including frequency of stroke recurrence, Patient Global Impression of Change (PGIC) scale, peak systolic velocities (PSV), and cerebral perfusion. Results During the whole RIC treatment process, no RIC‐related adverse event occurred. Only one of 30 patients suffered a onetime infarction (3.3%), and the ratios of acceptable PGIC were 88.2%, 64.3%, and 92.3% at 0.5, 1, and 2 years follow‐up. Kaplan‐Meier analysis showed the frequency of stroke recurrence was significantly reduced after RIC (P = .013). The frequency of TIA per week was 1.1 (0.6, 2.8) prior to RIC and 0.1 (0.0, 0.5) post‐RIC (P < .01). Compared to baseline, PSV values were significantly reduced after RIC treatment (P = .002 at 0.5, P = .331 at 1, and P = .006 at 2 years). In patients undergoing perfusion studies, 75% obtained improvement on followed‐up SPECT and 95% on followed‐up PET maps. Conclusions Remote ischemic conditioning may be beneficial on controlling iMMD‐induced ischemic events, relieving symptoms, and improving cerebral perfusion, without incidence of complications in this case series.

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Section: Discussionsupporting

confidence: 54%

Remote ischemic conditioning for the treatment of ischemic moyamoya disease

et al. 2019

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“…To define cerebral misery perfusion, PET studies were performed using a SET-3000GCT/M scanner (PET/CT; Shimadzu) for healthy subjects. 29 To detect cerebral misery perfusion, patients underwent the same PET studies more than 3 weeks after the last ischemic event. 29 Before emission scans, a transmission scan (3 minutes) with a 137 Cs point source was performed using a bismuth germanate transmission detector ring coaxially attached to the gadolinium silica oxide emission detector ring.…”

Section: Brain 15 O Gas Pet Studymentioning

confidence: 99%

“…which prevents further cerebral ischemic events. 15,29,30,33 In particular, it is recommended for the symptomatic cerebral hemisphere that shows compromised hemodynamics such as misery perfusion. 11,22 A recent study has demonstrated that although the majority of adult patients undergoing revascularization surgery for MMD show no significant change in cognition compared with their preoperative performance, a small proportion of such patients show apparent improvement in cognition after surgery.…”

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confidence: 99%

Impact of cerebral blood flow changes due to arterial bypass surgery on cognitive function in adult patients with symptomatic ischemic moyamoya disease

Yanagihara

Chida

Kobayashi

et al. 2019

Journal of Neurosurgery

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OBJECTIVESome adult patients with moyamoya disease (MMD) undergoing revascularization surgery show an improvement or decline in cognition postoperatively. Revascularization surgery for ischemic MMD augments cerebral blood flow (CBF) and improves cerebral oxygen metabolism. However, cerebral hyperperfusion, which is a short-term, major increase in ipsilateral CBF that is much greater than the metabolic needs of the brain, sometimes occurs as a complication. Cerebral hyperperfusion produces widespread, minimal injury to the ipsilateral white matter and cortical regions. The aim of the present prospective study was to determine how changes in CBF due to arterial bypass surgery affect cognitive function in adult patients with symptomatic ischemic MMD and misery perfusion.METHODSThirty-two patients with cerebral misery perfusion, as determined on the basis of 15O gas positron emission tomography, underwent single superficial temporal artery–middle cerebral artery (M4 in the precentral region) anastomosis. Brain perfusion single-photon emission computed tomography (SPECT) studies were performed preoperatively, on the 1st postoperative day, and 2 months after surgery. Neuropsychological tests were also performed preoperatively and 2 months after surgery.RESULTSPostoperative neuropsychological assessments demonstrated cognitive improvement in 10 cases (31%), no change in 8 cases (25%), and decline in 14 cases (44%). Based on brain perfusion SPECT and symptoms, 10 patients were considered to have cerebral hyperperfusion syndrome, and all of these patients exhibited a postoperative decline in cognition. Relative precentral CBF on the 1st postoperative day was significantly greater in patients with postoperative cognitive decline (167.3% ± 15.3%) than in those with improved (105.3% ± 18.2%; p < 0.0001) or unchanged (131.4% ± 32.1%; p = 0.0029) cognition. The difference between relative precentral CBF 2 months after surgery and that before surgery was significantly greater in patients with postoperative cognitive improvement (17.2% ± 3.8%) than in those with no postoperative change (10.1% ± 2.4%; p = 0.0003) or with postoperative decline (11.5% ± 3.2%; p = 0.0009) in cognition.CONCLUSIONSCerebral hyperperfusion in the acute stage after arterial bypass surgery impairs cognitive function. An increase in CBF in the chronic stage without acute-stage cerebral hyperperfusion improves cognitive function in adult patients with symptomatic ischemic MMD and misery perfusion.

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“…To assess cerebral perfusion, a brain N-isopropyl-p-(123I)-iodoamphetamine (IMP) SPECT study was performed using a triple-head gamma camera (GCA-9300R; Toshiba Medical Systems, Tochigi, Japan) [10]. For patients who experienced ischemic symptoms, this study was performed more than 3 weeks after the last ischemic event.…”

Section: Brain Spect and Pet Studiesmentioning

confidence: 99%

“…After intravenous infusion of 222 MBq 123 I-IMP, data acquisition was performed at a mid-scan time of 30 min for a scan duration of 20 min. The SPECT acquisition protocol, post-acquisition processing, and correction were performed as described previously [10]. The brain 123 I-IMP SPECT study was also performed in the same manner 6 months after surgery.…”

Section: Brain Spect and Pet Studiesmentioning

confidence: 99%

Reduced Hypoxic Tissue and Cognitive Improvement after Revascularization Surgery for Chronic Cerebral Ischemia

et al. 2019

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Background: Hypoxic but viable neural tissue is seen on 1-(2–¹⁸F-fluoro-1-[hydroxymethyl]ethoxy) methyl-2-nitroimidazole (¹⁸F-FRP170) positron emission tomography (PET) in patients with chronic cerebral ischemia with a combination of misery perfusion and moderately reduced oxygen metabolism. Cognitive function sometimes improves after revascularization surgery in patients with chronic cerebral ischemia. Objectives: We used brain perfusion single-photon emission computed tomography (SPECT) and ¹⁸F-FRP170 PET to determine whether hypoxic tissue was reduced following the restoration of cerebral perfusion after carotid endarterectomy (CEA) in patients with severe stenosis of the cervical internal carotid artery (ICA) and whether the reduction in hypoxic tissue was associated with cognitive improvement. Method: Eighteen patients with abnormally reduced cerebral blood flow (CBF) in the affected cerebral hemispheres on preoperative brain perfusion SPECT underwent CEA. They underwent ¹⁸F-FRP170 PET and neuropsychological tests preoperatively and 6 months postoperatively. Brain perfusion SPECT was also performed 6 months postoperatively. Regions of interest were placed in the bilateral middle cerebral artery territories on SPECT and PET images, and the ratio of values in the affected versus contralateral hemispheres was calculated. Results: The CBF ratio (p = 0.0006) and ¹⁸F-FRP170 ratio (p = 0.0084) were significantly increased and reduced, respectively, after surgery compared to the corresponding ratios before surgery. The difference in the ¹⁸F-FRP170 ratio (postoperative – preoperative value) was negatively correlated with the difference in the CBF ratio (ρ = –0.695; p = 0.0009). The difference in the ¹⁸F-FRP170 ratio was significantly lower in patients with postoperative improved cognition compared to that in those without (p = 0.0007). The area under the receiver operating characteristics curve for the difference in the ¹⁸F-FRP170 ratio for detecting postoperative improved cognition was significantly greater than that for the difference in the CBF ratio (difference between areas, 0.278; p = 0.0248). Conclusions: Hypoxic tissue is reduced following the restoration of cerebral perfusion with revascularization surgery in patients with severe atherosclerotic stenosis of the cervical ICA. The reduction in hypoxic tissue is associated with cognitive improvement in such patients.

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Preoperatively reduced cerebrovascular contractile reactivity to hypocapnia by hyperventilation is associated with cerebral hyperperfusion syndrome after arterial bypass surgery for adult patients with cerebral misery perfusion due to ischemic moyamoya disease

Cited by 30 publications

References 30 publications

Remote ischemic conditioning for the treatment of ischemic moyamoya disease

Remote ischemic conditioning for the treatment of ischemic moyamoya disease

Impact of cerebral blood flow changes due to arterial bypass surgery on cognitive function in adult patients with symptomatic ischemic moyamoya disease

Reduced Hypoxic Tissue and Cognitive Improvement after Revascularization Surgery for Chronic Cerebral Ischemia

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