Brain Perfusion Measurement for Patients undergoing Reconstructive Surgery for Main Cerebral Arteries in the Era of Restriction for Acetazolamide Challenge

Abstract

  The Japanese acetazolamide challenge guidelines for measuring brain perfusion describe how measuring cerebrovascular reactivity to acetazolamide is necessary for deciding the indication of arterial bypass surgery for cerebrovascular occlusive diseases and for predicting major adverse events such as cerebral hyperperfusion syndrome after carotid endarterectomy or stenting. The guidelines also recommend the development and dissemination of alternative methods to detect cerebral hemodynamic impairment. Therefore, I propose performing these examinations to determine the indication of arterial bypass surgery in the order as follows : left-right asymmetry of cerebral blood flow in the cerebral and cerebellar hemispheres, combination of cerebral blood flow and iomazenil SPECT imaging, and cerebrovascular reactivity to acetazolamide. I also propose performing these examinations to predict cerebral hyperperfusion syndrome after carotid endarterectomy or stenting in the order as follows : MCA signal intensity on MRA and cerebrovascular reactivity to acetazolamide. Using these alternative examination methods can reduce the frequency of acetazolamide challenge by half.