BACKGROUND: Cerebral hyperperfusion syndrome sometimes occurs after carotid revascularization in patients with severe hemodynamic failure. To prevent cerebral hyperperfusion syndrome, cerebral hyperperfusion phenomenon (CHP) must be detected early. Single-photon emission computed tomography (SPECT) is useful for detecting CHP, but it is impractical on a daily basis. A tool with high availability to find CHP is desired.
OBJECTIVE: To investigate whether global oxygen extraction fraction (OEF) by a blood sampling method is useful for indicating CHP after carotid artery stenting (CAS).
METHODS: When patients underwent elective CAS from September 2010 to August 2012, we performed blood sampling for OEF calculation and SPECT before and immediately after elective CAS. Data were collected prospectively. OEF was calculated from the cerebral arteriovenous oxygen difference. Cerebral blood flow was measured in the affected middle cerebral artery (MCA) territory and in the ipsilateral cerebellum by SPECT. The ratio of MCA to cerebellar activity was defined as cerebral blood flow in the affected MCA territory divided by cerebral blood flow in the ipsilateral cerebellar hemisphere. Probable CHP was defined as ≥10% increase in the ratio of MCA to cerebellar activity after CAS. The relationship between peri-CAS OEF and probable CHP was evaluated.
RESULTS: Of the 96 patients enrolled, 92 patients were analyzed. Probable CHP occurred in 17 patients. Post-CAS OEF was related to probable CHP (P < .01), but pre-CAS OEF was not. The receiver-operating characteristic curve showed that the cutoff value was 45% for probable CHP (P < .001).
CONCLUSION: An increase in blood sampling OEF immediately after CAS was related to probable CHP; then the oxygen demand should be reduced.
ABBREVIATIONS: AVDO2, arteriovenous oxygen difference
AI, asymmetry index
CAS, carotid artery stenting
CEA, carotid endarterectomy
CBF, cerebral blood flow
CHP, cerebral hyperperfusion phenomenon
CHS, cerebral hyperperfusion syndrome
CMRO2, cerebral metabolic rate of oxygen
123I-IMP, I123-labeled N-isopropyl-p-iodoamphetamine
IQR, interquartile range
MCA, middle cerebral artery
MCA/CE, ratio of middle cerebral artery to cerebellar activity
OEF, oxygen extraction fraction
rCBF, regional cerebral blood flow
SPECT, single-photon emission computed tomography
Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Kamakura City, Kanagawa, Japan
Correspondence: Takahisa Mori, MD, PhD, Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Okamoto 1370-1, Kamakura City, Kanagawa 247-8533, Japan. E-mail: firstname.lastname@example.org
Received March 17, 2014
Accepted June 18, 2014