定量SPECTをもとにした内頚動脈内膜剝離術周術期における過灌流評価の検討

抄録

Background: Cerebral hyperperfusion after carotid endarterectomy (CEA) is an important target for perioperative care, as it can lead to postoperative intracerebral hemorrhage (ICH), a devastating complication. Previous reports have suggested that quantitative single-photon emission computed tomography (SPECT) is useful for detecting and predicting cerebral hyperperfusion. The purpose of this study was to examine retrospectively the validity and usefulness of quantitative SPECT for perioperative care in our department.
Methods: Fifty-eight patients undergoing CEA were preoperatively assessed by SPECT for cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) to acetazolamide. We defined hyperperfusion tendency as a > 100% increase compared with preoperative values or focal hyperperfusion with a right/left difference compared with contralateral values. We strictly controlled postoperative blood pressure in patients with preoperatively reduced CVR, acute major stroke, or postoperative hyperperfusion tendency.
Results: Postoperative hyperperfusion tendency was found in eight patients (13.8%), but only one of these showed classic hyperperfusion, marked by a > 100% increase. No patient developed ICH, but two patients developed renal dysfunction and required temporary dialysis due to induced hypotension. As reported previously, we found that reduced preoperative CVR and a high degree of stenosis were significant risk factors for hyperperfusion tendency. The hyperperfusion tendency of patients with acute cerebral infarction tended to progress slowly.
Conclusion: Selective blood pressure control based on pre- and postoperative quantitative SPECT analysis is useful. Postoperative management of patients with acute cerebral infarction and overestimation of the hyperperfusion tendency due to the variability in quantitative SPECT requires further attention.