Preoperatively reduced cerebrovascular contractile reactivity to hypocapnia by hyperventilation is associated with cerebral hyperperfusion syndrome after arterial bypass surgery for adult patients with cerebral misery perfusion due to ischemic moyamoya disease

被引:33
|
作者
Sato, Shinpei [1 ]
Kojima, Daigo [1 ,2 ]
Shimada, Yasuyoshi [1 ,2 ]
Yoshida, Jun [1 ,2 ]
Fujimato, Kentaro [1 ]
Fujiwara, Shunrou [1 ]
Kobayashi, Masakazu [1 ,2 ]
Kubo, Yoshitaka [1 ]
Yoshida, Kenji [1 ]
Terasaki, Kazunori [2 ]
Tsutsui, Shouta [1 ]
Miyoshi, Kenya [1 ]
Ogasawara, Kuniaki [1 ,2 ]
机构
[1] Iwate Med Univ, Sch Med, Dept Neurosurg, Morioka, Iwate, Japan
[2] Iwate Med Univ, Sch Med, Cyclotron Res Ctr, Morioka, Iwate, Japan
来源
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM | 2018年 / 38卷 / 06期
基金
日本学术振兴会;
关键词
Moyamoya disease; hyperperfusion syndrome; hypocapnia; misery perfusion; single-photon emission computed tomography; EXTRACRANIAL-INTRACRANIAL BYPASS; POSITRON-EMISSION-TOMOGRAPHY; BLOOD-FLOW; NEUROLOGICAL DETERIORATION; QUANTITATIVE MEASUREMENT; COMPUTED-TOMOGRAPHY; BRAIN; SPECT; REVASCULARIZATION; ANASTOMOSIS;
D O I
10.1177/0271678X18757621
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The present study examined whether preoperatively reduced cerebrovascular contractile reactivity to hypocapnia by hyperventilation is associated with development of cerebral hyperperfusion syndrome after arterial bypass surgery for adult patients with cerebral misery perfusion due to ischemic moyamoya disease. Among 65 adult patients with ischemic moyamoya disease, 19 had misery perfusion in the precentral region on preoperative O-15 positron emission tomography and underwent arterial bypass surgery for that region. Brain technetium-99m-labeled ethyl cysteinate dimer single-photon emission computed tomography (SPECT) was preoperatively performed with and without hyperventilation challenge and relative cerebrovascular contractile reactivity to hypocapnia (RCVCRhypocap) (%/mmHg) was calculated in the precentral region. Development of cerebral hyperperfusion syndrome was determined using perioperative changes of symptoms and brain N-isopropyl-p-[I-123]-iodoamphetamine SPECT performed after surgery. RCVCRhypocap was significantly lower in the 6 patients with cerebral hyperperfusion syndrome (-2.85 +/- 1.10%/mmHg) than in the 13 patients without cerebral hyperperfusion syndrome (0.18 +/- 1.97%/mmHg; p = 0.0050). Multivariate analysis demonstrated low RCVCRhypocap as an independent predictor of cerebral hyperperfusion syndrome (95% confidence interval, 0.04-0.96; p = 0.0433). Preoperatively reduced cerebrovascular contractile reactivity to hypocapnia by hyperventilation is associated with development of cerebral hyperperfusion syndrome after arterial bypass surgery for adult patients with cerebral misery perfusion due to ischemic moyamoya disease.
引用
收藏
页码:1021 / 1031
页数:11
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