Cerebral Hyperperfusion Following Carotid Endarterectomy: Diagnostic Utility of Intraoperative Transcranial Doppler Ultrasonography Compared with Single-Photon Emission Computed Tomography Study
Kuniaki Ogasawaraa,b,
Takashi Inouea,b,
Masakazu Kobayashia,b,
Hidehoko Endoa,b,
Kenji Yoshidaa,b,
Takeshi Fukudaa,b,
Kazunori Terasakib and
Akira Ogawaa,b
a Department of Neurosurgery, Iwate Medical University
b Cyclotron Research Center, Iwate Medical University
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FIG 1. Intraoperative BFV after ICA declamping, expressed as percentages of preclamping BFV values, for patients with post-CEA hyperperfusion (n = 6). Arrow indicates patient that developed hyperperfusion syndrome.
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FIG 2. Intraoperative BFV after ICA declamping, expressed as percentages of preclamping BFV values, for patients without post-CEA hyperperfusion (n = 54).
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FIG 3. Correlation between BFV increases immediately after ICA declamping and CBF increases immediately after CEA. Curved line indicates cubic function of the best fit; arrow, patient that developed hyperperfusion syndrome; horizontal dashed line, CBF increase of 100% (the definition of hyperperfusion).
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FIG 4. Correlation between BFV increases at the end of the procedure and CBF increases immediately after CEA. Curved line indicates quartic function of the best fit; arrow, patient that developed hyperperfusion syndrome; horizontal dashed line, CBF increase of 100% (the definition of hyperperfusion).
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FIG 5. A 75-year-old man with symptomatic lacunar infarcts in the right cerebral hemisphere and asymptomatic left ICA stenosis (90%) that exhibited hyperperfusion syndrome 6 days after CEA.
A, SPECT scans obtained preoperatively (left) and immediately after CEA (right) show postoperative hyperperfusion in the entire ipsilateral cerebral hemisphere.
B, TCD monitoring of the left middle cerebral artery during CEA reveals systolic blood flow velocity of 2.9-fold of preclamp values immediately after declamping. The value increased to 3.6-fold at the end of the procedure.
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