Department of Neurosurgery, University of Tsukuba.
Department of Neurosurgery, Tsukuba Medical Center Hospital.
Neurol Med Chir (Tokyo). 2020 Feb 15;60(2):94-100. doi: 10.2176/nmc.oa.2019-0114. Epub 2019 Dec 21.
The purpose of this study was to investigate the relationship between the cerebral hyperperfusion phenomenon (CHP) and carotid artery flow volume as measured by a transit time flowmeter during carotid endarterectomy (CEA). We retrospectively investigated 74 patients who underwent both transit time flowmetry and single photon emission computed tomography (SPECT). The flow volumes of the internal carotid artery (ICA) before and after the endarterectomy were recorded during surgery as the pre- and the post-ICA (mL/min), respectively. We defined the difference between the pre- and the post-ICA as the ΔIC (mL/min). Two independent board-certified neurosurgeons analyzed the asymmetry index (affected side/contralateral side) of regional qualitative cerebral blood flow before and after the CEA respectively. We defined the CHP as an excessive increase in this asymmetry index between preoperative and postoperative SPECT. The CHP was observed in five of the 74 patients (6.8%). The pre-ICA of the CHP cases was significantly lower than that of the non-CHP cases (in mL/min, median 29 vs. 97; P = 0.01). The ΔIC of the CHP cases was significantly higher than that of the non-CHP cases (in mL/min, median 154 vs. 50; P = 0.002). The cut-off value of the ΔIC was 81 mL/min (sensitivity 100%, specificity 78.3%, area under the curve 0.912). The findings of this study suggest that the ΔIC is associated with the CHP. The transit time flowmeter is useful to predict the CHP during surgery.
本研究旨在探讨颈动脉内膜切除术（CEA）期间通过渡越时间流量计测量的脑过度灌注现象（CHP）与颈内动脉血流量之间的关系。我们回顾性调查了 74 例同时进行渡越时间流量计和单光子发射计算机断层扫描（SPECT）的患者。手术期间记录了颈动脉内膜切除术前和术后颈内动脉（ICA）的血流量，分别为术前 ICA（mL/min）和术后 ICA。我们将术前和术后 ICA 的差值定义为ΔICA（mL/min）。两名独立的认证神经外科医生分别分析了 CEA 前后区域定性脑血流的不对称指数（患侧/对侧）。我们将 CHP 定义为术前和术后 SPECT 之间这种不对称指数的过度增加。在 74 例患者中，有 5 例（6.8%）观察到 CHP。CHP 病例的术前 ICA 明显低于非 CHP 病例（以 mL/min 计，中位数为 29 比 97；P = 0.01）。CHP 病例的ΔICA 明显高于非 CHP 病例（以 mL/min 计，中位数为 154 比 50；P = 0.002）。ΔICA 的截止值为 81 mL/min（灵敏度 100%，特异性 78.3%，曲线下面积 0.912）。本研究结果表明，ΔICA 与 CHP 相关。渡越时间流量计可用于预测手术中的 CHP。
