title: Postcarotid endarterectomy cerebral hyperperfusion can be prevented by minimizing intraoperative cerebral ischemia and strict postoperative blood pressure control under continuous sedation.
abstract: OBJECTIVE
  Cerebral hyperperfusion syndrome is a major complication after carotid endarterectomy (CEA). We investigated whether our strategy of minimizing intraoperative cerebral ischemia and strict postoperative blood pressure control under continuous sedation prevented postoperative hyperperfusion.
  
  
  METHODS
  Eighty consecutive patients undergoing CEA were studied. A shunt was used in all patients during CEA. All patients were managed postoperatively under continuous sedation for as long as 48 hours on the basis of the regional cerebral blood flow (rCBF) measured immediately after CEA. Postoperative hyperperfusion was assessed, on the basis of the cerebral blood flow study under sedation (propofol) after CEA, either as a greater than 30% increase in rCBF compared with the contralateral side, or a greater than 100% increase in the corrected rCBF (calculated from percentage reduction of the contralateral rCBF induced by propofol) compared with preoperative values.
  
  
  RESULTS
  No patient developed cerebral hyperperfusion syndrome. Postoperative hyperperfusion was found at very low rates (2.5% in the middle cerebral artery territory and 1.3% in the anterior cerebral artery territory by definition 1, and 0% in both territories by definition 2). Ratios of regional oxygen saturation after internal carotid artery clamping to preclamp baseline values were greater than 0.9 in 78 of 80 patients, indicating very mild intraoperative cerebral ischemia. Parameters related to cerebral ischemia during CEA, such as regional oxygen saturation, internal carotid artery cross-clamping duration, and stump pressure (index), did not affect the incidence of postoperative hyperperfusion.
  
  
  CONCLUSIONS
  The present study suggests that minimizing intraoperative cerebral ischemia using a shunt, followed by strict postoperative blood pressure control under continuous sedation, can prevent post-CEA hyperperfusion.
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan. tkawamata@nij.twmu.ac.jp
authors.forename: Takakazu
authors.initials: T
authors.lastname: Kawamata
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
authors.forename: Akitsugu
authors.initials: A
authors.lastname: Kawashima
authors.forename: Taku
authors.initials: T
authors.lastname: Yoneyama
authors.forename: Kohji
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ono
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Hori
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D002545:Brain Ischemia / Q000209:etiology* / Q000517:prevention & control*; D003131:Combined Modality Therapy; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents