title: Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning.
abstract: OBJECTIVE
  The purpose of this study was to determine whether the preoperative measurement of acetazolamide-induced changes in cerebral blood flow (CBF), which is performed using single-photon emission computerized tomography (SPECT) scanning, can be used to identify patients at risk for hyperperfusion following carotid endarterectomy (CEA). In addition, the authors investigated whether monitoring of CBF with SPECT scanning after CEA can be used to identify patients at risk for hyperperfusion syndrome.
  
  
  METHODS
  Cerebral blood flow and cerebrovascular reactivity (CVR) to acetazolamide were measured before CEA in 51 patients with ipsilateral internal carotid artery stenosis (> or = 70% stenosis). Cerebral blood flow was also measured immediately after CEA and on the 3rd postoperative day. Hyperperfusion (an increase in CBF of > or = 100% compared with preoperative values) was observed immediately after CEA in eight of 12 patients with reduced preoperative CVR. Reduced preoperative CVR was the only significant independent predictor of post-CEA hyperperfusion. Forty-three patients in whom hyperperfusion was not detected immediately after CEA did not exhibit hyperperfusion on the 3rd postoperative day and did not experience hyperperfusion syndrome. In two of eight patients in whom hyperperfusion occurred immediately after CEA, CBF progressively increased and hyperperfusion syndrome developed, but intracerebral hemorrhage did not occur. In the remaining six of eight patients in whom hyperperfusion was detected immediately after CEA, the CBF progressively decreased and the hyperperfusion resolved by the 3rd postoperative day.
  
  
  CONCLUSIONS
  Preoperative measurement of acetazolamide-induced changes in CBF, which is performed using SPECT scanning, can be used to identify patients at risk for hyperperfusion after CEA. In addition, post-CEA monitoring of CBF performed using SPECT scanning results in the timely and reliable identification of patients at risk for hyperperfusion syndrome.
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan. kuogasa@iwate-med.ac.jp
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Yukawa
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Chiaki
authors.initials: C
authors.lastname: Mikami
authors.forename: Hiromu
authors.initials: H
authors.lastname: Konno
authors.forename: Kazunori
authors.initials: K
authors.lastname: Terasaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Inoue
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
mesh_terms: D000086:Acetazolamide / Q000494:pharmacology; D000368:Aged; D000927:Anticonvulsants / Q000494:pharmacology; D002539:Cerebral Arterial Diseases / Q000175:diagnosis / Q000209:etiology*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012306:Risk; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D000927:Anticonvulsants; D000086:Acetazolamide