Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Post-Carotid Endarterectomy Cerebral Hyperperfusion Syndrome : Is It Preventable by Strict Blood Pressure Control?

  • Kim, Kyung Hyun (Department of Neurosurgery, Seoul National University Hospital) ;
  • Lee, Chang-Hyun (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Son, Young-Je (Department of Neurosurgery, SMG-SNU Boramae Medical Center) ;
  • Yang, Hee-Jin (Department of Neurosurgery, SMG-SNU Boramae Medical Center) ;
  • Chung, Young Sub (Department of Neurosurgery, SMG-SNU Boramae Medical Center) ;
  • Lee, Sang Hyung (Department of Neurosurgery, SMG-SNU Boramae Medical Center)
  • Received : 2013.03.30
  • Accepted : 2013.09.08
  • Published : 2013.09.28
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Abstract

Objective : Cerebral hyperperfusion syndrome (CHS) is a serious complication after carotid endarterectomy (CEA). However, the prevalence of CHS has decreased as techniques have improved. This study evaluates the role of strict blood pressure (BP) control for the prevention of CHS. Methods : All 18 patients who received CEA from February 2009 through November 2012 were retrospectively reviewed. All patients were routinely managed in an intensive care unit by a same protocol. The cerebral perfusion state was evaluated on the basis of the regional cerebral blood flow (rCBF) study by perfusion computed tomography (pCT) and mean velocity by transcranial doppler (TCD). BP was strictly controlled (<140/90 mm Hg) for 7 days. When either post-CEA hyperperfusion (>100% increase in the rCBF by pCT or in the mean velocity by TCD compared with preoperative values) or CHS was detected, BP was maintained below 120/80 mm Hg. Results : TCD and pCT data on the patients were analyzed. Ipsilateral rCBF was significantly increased after CEA in the pCT (p=0.049). Post-CEA hyperperfusion was observed in 3 patients (18.7%) in the pCT and 2 patients (12.5%) in the TCD study. No patients developed clinical CHS for one month after CEA. Furthermore, no patients developed additional neurological deficits related to postoperative cerebrovascular complications. Conclusion : Intensive care with strict BP control (<140/90 mm Hg) achieved a low prevalence of post-CEA hyperperfusion and prevented CHS. This study suggests that intensive care with strict BP control can prevent the prevalence of post-CEA CHS.

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References

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