Abstract
We review cerebral hyperperfusion following carotid endarterectomy (CEA).
Persistence of cerebral hyperperfusion greater than several days after CEA is associated with development of hyperperfusion syndrome. Postoperative cerebral hyperperfusion, even when asymptomatic, is associated with impairment of cognitive function in patients undergoing CEA. Further, development of hyperperfusion syndrome is associated with persistent postoperative cognitive impairment. Pretreatment with a novel free radical scavenger—edaravone—prevents occurrence of cerebral hyperperfusion itself after CEA. Intraoperative monitoring of transcranial regional cerebral oxygen saturation using near-infrared spectroscopy or monitoring of intraoperative middle cerebral artery blood flow velocity using transcranial Doppler ultrasonography identifies patients at risk for hyperperfusion after CEA. Reduced preoperative cerebrovascular reactivity to acetazolamide is a significant independent predictor of post-CEA hyperperfusion.
