Abstract
Objectives: The significance of preoperative cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) measurement in patients with carotid artery stenosis was evaluated. Methods: Two-hundred and twenty surgeries [carotid endarterectomy (CEA): 99, carotid artery stenting (CAS): 121] in which preoperative CBF measurement with single photon emission computed tomography was done were studied. CBF was evaluated as type I, II and III, using Kuroda’s CBF classification. The number of type I was 115 (CEA: 35, CAS: 80), that of type II was 83 (CEA: 46, CAS: 37), and that of type III was 22 (CEA: 18, CAS: 4). Results: Postoperative ischemic lesions on diffusion-weighted magnetic resonance imaging was detected in 28 (24.3%) cases in type I, in 21 (25.3%) cases in type II, and in two (9.1%) cases in type III. There were no significant differences among these type groups. These lesions were detected frequently in CAS than in CEA, and a significant difference was recognized in type I between CEA and CAS. Postoperative ischemic neurological symptoms were recognized in 5 (4.3%) cases in type I, in 1 (1.2%) cases in type II, and in 2 (9.1%) cases in type III, and there were no significant differences among these type groups. Symptoms were recognized frequently in CAS than in CEA, but these differences were not significant. Postoperative hyperperfusion syndrome was observed in 0 (0.0%) cases in type I, in 2 (2.4%) cases in type II, and in 4 (18.2%) cases in type III. This syndrome was recognized more frequently in type III than in other types. There was no significant difference in occurrence of hyperperfusion syndrome, when comparing CEA and CAS. Conclusions: Preoperative CVR is related to the occurrence of postoperative hyperperfusion syndrome and can be used to predict hyperperfusion syndrome causing fatal cerebral hemorrhage.
