Evaluation of carotid distal pressure for prevention of hyperperfusion after carotid endarterectomy.
BACKGROUND
Sometimes preoperative cerebral misery perfusion induces an occurrence of hyperperfusion after carotid endarterectomy (CEA). We intraoperatively measured carotid proximal and distal pressures and evaluated their role in predicting hyperperfusion.


METHODS
Twenty-one sites with an indication of CEA were preoperatively assessed based on the bilateral perfusional state of the cerebral blood flow (CBF) and delta CBF by single photon emission computed tomography (SPECT). Postoperative SPECT was performed immediately and on the fifth day after surgery. The distal and proximal pressures were intraoperatively measured through an internal shunt tube, and the evaluated relationship against hyperperfusion was shown on postoperative SPECT.


RESULTS
Despite strict control of blood pressure, 7 patients postoperatively showed hyperperfusion on SPECT and 2 of them had transient neurological symptoms. The distal pressure was significantly different between the postoperative hyperperfusion group and the normal one; however, proximal pressure and the difference between proximal and distal pressures were not significantly different. In the hyperperfusion group, delta pressure was apparently higher, and delta CBF and distal pressure were significantly lower than those of the normal group.


CONCLUSIONS
Intraoperative measurement of distal pressure as well as preoperative estimation of the cerebrovascular perfusion and the reserve is of importance in predicting postoperative hyperperfusion.
Yoshimoto
Tetsuyuki
T
Kashiwaba Neurosurgical Hospital, Tsukisamu, Toyohira-ku, Sapporo 062-8513, Japan. tzkamer7@amber.plala.or.jp
Shirasaka
Tomohide
T
Yoshizumi
Takeshi
T
Fujimoto
Shin
S
Kaneko
Sadao
S
Kashiwaba
Takeshi
T
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D016893:Carotid Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology / Q000601:surgery*; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods; D018579:Patient Selection; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011379:Prognosis; D015899:Tomography, Emission-Computed, Single-Photon