Kono Kenichi, Wakugawa Yoshiyuki, Uda Ken, Yasaka Masahiro, Okada Yasushi, Nagata Shinji
Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Japan.
No Shinkei Geka. 2011 Feb;39(2):149-54.
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.
高灌注综合征是颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS）后的一种严重并发症。一些报告表明，经颅彩色编码超声（TCCS）检测患侧大脑中动脉（MCA）平均血流速度（MFV）比值升高，有助于评估CEA或CAS术后的高灌注情况。我们报告一例CAS术后高灌注综合征病例，其中不仅基于术前平均血流速度的患侧比值升高，而且左右比值（L/R比值）对监测高灌注也有帮助。一名48岁男性因右侧颈内动脉（ICA）起始部狭窄导致右侧ICA脑梗死入住我院。术前TCCS检测MCA的MFV的L/R比值为0.58。我们进行了CAS手术，患者随后出现伴有癫痫的高灌注综合征，并在严格控制血压的管理下进行了气管插管。我们每天进行TCCS检测，当MCA的MFV的L/R比值从最高的2.6降至1.1时，患者拔管，尽管患侧MCA的MFV升高比值仍高于1.4。患者出院时无高灌注相关并发症。当术前存在脑血流的左右差异时，TCCS检测的MFV的L/R比值可用于监测CEA或CAS术后的高灌注情况。
