title: [Left to right ratio of transcranial color-coded sonography for monitoring hyperperfusion syndrome after carotid artery stenting: a case report].
abstract: Hyperperfusion syndrome is a significant complication after carotid endarterectomy (CEA) or carotid artery stenting (CAS). A few reports have shown that an increase in the ratio of mean flow velocity (MFV) of the middle cerebral artery (MCA) of the affected side by transcranial color-coded sonography (TCCS) is useful for the evaluation of hyperperfusion after CEA or CAS. We report a case of hyperperfusion syndrome after CAS in which not only the increased ratio of the affected side based on preoperative mean flow velocity, but also the left to right ratio (L/R ratio) was useful for monitoring hyperperfusion. A 48-year-old man was admitted to our hospital because of cerebral infarction of the right internal carotid artery (ICA) due to stenosis of the right ICA at origin. The preoperative L/R ratio of MFV of the MCA by TCCS was 0.58. We performed CAS and the patient then developed hyperperfusion syndrome with epilepsy and was intubated under the management of strict blood control. We performed TCCS daily and the patient was extubated when the L/R ratio of MFV of the MCA decreased to 1.1 from a maximum of 2.6, although the increased ratio of MFV of the MCA of the affected side was still higher than 1.4. The patient went home without any complications from hyperperfusion. When there is preoperative laterality of cerebral blood flow, the L/R ratio of MFV by TCCS can be useful for monitoring hyperperfusion after CEA or CAS.
authors.affiliation: Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kono
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Wakugawa
authors.forename: Ken
authors.initials: K
authors.lastname: Uda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yasaka
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagata
mesh_terms: D001783:Blood Flow Velocity; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000628:therapy*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015607:Stents / Q000009:adverse effects*; D013577:Syndrome; D018615:Ultrasonography, Doppler, Color; D017585:Ultrasonography, Doppler, Transcranial