Komoribayashi Nobukazu, Ogasawara Kuniaki, Kobayashi Masakazu, Saitoh Hideo, Terasaki Kazunori, Inoue Takashi, Ogawa Akira
Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
J Cereb Blood Flow Metab. 2006 Jul;26(7):878-84. doi: 10.1038/sj.jcbfm.9600244. Epub 2005 Nov 9.
The aim of this study was to investigate whether postoperative hyperperfusion is associated with preoperative cerebral hemodynamic impairment due to chronic ischemia and with acute cerebral ischemia during clamping of the internal carotid artery (ICA) during carotid endarterectomy (CEA). Transcranial cerebral oxygen saturation (SO2) was monitored intraoperatively using near-infrared spectroscopy in 89 patients undergoing CEA for ipsilateral ICA stenosis (>70%). Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to acetazolamide were also measured using single photon emission computed tomography (SPECT) before CEA. In addition, CBF was measured immediately after CEA and on the third postoperative day. Hyperperfusion (CBF increase>100% compared with preoperative values) was observed immediately after CEA in 10 of 18 patients (56%) with reduced preoperative CVR. Also, post-CEA hyperperfusion was observed in nine of 16 patients (56%) whose SO2 during clamping of the ICA decreased to less than 90% of the preclamping value. Logistic regression analysis showed that reduced preoperative CVR and reduced SO2 during ICA clamping were significant independent predictors of the development of hyperperfusion immediately after CEA. In fact, all patients with reduced preoperative CVR and reduced SO2 during ICA clamping developed post-CEA hyperperfusion, and two of these patients developed cerebral hyperperfusion syndrome. These data suggest that development of cerebral hyperperfusion after CEA is associated with preoperative hemodynamic impairment and intraoperative cerebral ischemia.
本研究的目的是调查术后高灌注是否与慢性缺血导致的术前脑血流动力学损害以及颈动脉内膜切除术（CEA）期间颈内动脉（ICA）夹闭时的急性脑缺血相关。在89例因同侧ICA狭窄（>70%）接受CEA的患者中，术中使用近红外光谱法监测经颅脑氧饱和度（SO2）。在CEA术前还使用单光子发射计算机断层扫描（SPECT）测量脑血流量（CBF）和对乙酰唑胺的脑血管反应性（CVR）。此外，在CEA术后即刻和术后第三天测量CBF。18例术前CVR降低的患者中有10例（56%）在CEA术后即刻出现高灌注（CBF较术前值增加>100%）。同样，在ICA夹闭期间SO2降至夹闭前值的90%以下的16例患者中有9例（56%）出现CEA术后高灌注。逻辑回归分析表明，术前CVR降低和ICA夹闭期间SO2降低是CEA术后即刻发生高灌注的显著独立预测因素。事实上，所有术前CVR降低且ICA夹闭期间SO2降低的患者均出现了CEA术后高灌注，其中2例患者发生了脑高灌注综合征。这些数据表明，CEA后脑高灌注的发生与术前血流动力学损害和术中脑缺血有关。
