Ogasawara Kuniaki, Yukawa Hirotsugu, Kobayashi Masakazu, Mikami Chiaki, Konno Hiromu, Terasaki Kazunori, Inoue Takashi, Ogawa Akira
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
J Neurosurg. 2003 Sep;99(3):504-10. doi: 10.3171/jns.2003.99.3.0504.
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.
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.
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.
本研究的目的是确定使用单光子发射计算机断层扫描（SPECT）扫描进行术前乙酰唑胺诱导的脑血流量（CBF）变化测量，是否可用于识别颈动脉内膜切除术（CEA）后发生高灌注风险的患者。此外，作者还研究了CEA后用SPECT扫描监测CBF是否可用于识别高灌注综合征风险的患者。
对51例同侧颈内动脉狭窄（狭窄≥70%）患者在CEA术前测量脑血流量及对乙酰唑胺的脑血管反应性（CVR）。在CEA术后即刻及术后第3天也测量脑血流量。术前CVR降低的12例患者中有8例在CEA术后即刻出现高灌注（与术前值相比CBF增加≥100%）。术前CVR降低是CEA后高灌注唯一显著的独立预测因素。43例在CEA术后即刻未检测到高灌注的患者在术后第3天未出现高灌注，也未发生高灌注综合征。在CEA术后即刻出现高灌注的8例患者中有2例，CBF逐渐增加并发生了高灌注综合征，但未发生脑出血。在CEA术后即刻检测到高灌注的其余6例患者中，CBF逐渐降低，到术后第3天高灌注消失。
使用SPECT扫描进行术前乙酰唑胺诱导的CBF变化测量，可用于识别CEA后发生高灌注风险的患者。此外，用SPECT扫描对CEA术后CBF进行监测能及时、可靠地识别高灌注综合征风险的患者。
