Measurement of cerebral reserve capacity using acetazolamide loading xenon CT CBF before carotid endarterectomy.
OBJECTIVE
Brain swelling and/or hemorrhage can occur after carotid endarterectomy. This phenomenon is called the hyperperfusion syndrome. Several factors contribute to this syndrome. One is reperfusion in a maximally dilated vessel which means disappearance of cerebral reserve capacity (CRC). The aim of the study was to determine whether CRC measurement was useful for intraoperative and postoperative management of carotid endarterectomy.


METHODS
We studied 64 cases (male 53, female 11), 49-79 years. CRC was measured preoperatively using acetazolamide loading Xenon CT CBF examination (XeCT). Hypothermia (34-35 C) was induced during surgery in a patient with no CRC. Anesthesia was maintained the night after surgery and the systolic blood pressure was controlled below 120 mmHg.


RESULTS
CRC was absent in 10 patients. Postoperative CT did not reveal any hemorrhage or brain swelling. One patient experienced a transient restless state.


CONCLUSIONS
and conclusions: Cerebral hyperperfusion syndrome has been reported in 0.3 approximately 6.0% of patients following carotid endarterectomy (vs 1.6% in our study without hemorrhage or brain swelling). These data suggest that information on CRC could be useful for selection and perioperative management of patients during carotid endarterectomy.
Yamashita
Tetsuo
T
Department of Neurosurgery, Central Hospital of Yamaguchi, Hofu, Japan. t2yama@ymg.urban.ne.jp
Urakawa
Manabu
M
Yasuda
Hiroaki
H
Matayoshi
Yasutoshi
Y
D000086:Acetazolamide; D000368:Aged; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014978:Xenon
D014978:Xenon; D000086:Acetazolamide