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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Cerebrovacular Reserve Predicts the Cerebral Hyperperfusion Syndrome After Carotid Endarterectomy
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Cerebrovacular Reserve Predicts the Cerebral Hyperperfusion Syndrome After Carotid Endarterectomy

机译：脑血管储备预测颈动脉内膜切除术后脑高抗冲综合征

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Background: Cerebral hyperperfusion syndrome is a rare but potentially severe complication of carotid artery revascularisation that develops under conditions of resistant postoperative hypertension and impaired cerebrovascular autoregulation. Objective: Was to determine which preoperative and operative factors affect the development of cerebral hyperperfusion syndrome after carotid endarterectomy. Methods: This prospective observational study enrolled 93 asymptomatic patients who underwent carotid endarterectomy. Cerebral hyperperfusion was registered in patients who had 100% postoperative increase in mean flow in middle cerebral artery registered by Transcranial Doppler ultrasound. Cerebral hyperperfusion syndrome was diagnosed in patients with cerebral hyperperfusion who postoperatively developed at least one of the symptoms. Pre-operative and operative risk factors for cerebral hyperperfusion syndrome were analysed by multivariate binary logistic regression. Results: Out of 93 operated patients, cerebral hyperperfusion was registered in 23 and cerebral hyperperfusion syndrome in 18 patients. Risk factors for cerebral hyperperfusion syndrome were included in the binary logistic regression model. Incomplete Circle of Willis morphology on 3D TOF magnetic resonance image (p = 0.002), Breath holding index below the 0.69 cut-off (p = 0.006), positive criteria for insufficient collateral flow through circle of Willis registered by TCD (p = 0.03), and poorly controlled hypertension (p = 0.023) showed statistically significant independent predictive value for cerebral hyperperfusion syndrome. The model was statistically significant (p = 0.012) and correctly classified 90.3 % of patients. Conclusions: Incomplete circle of Willis and insufficient collateral flow, low cerebrovascular reserve, and poorly regulated hypertension are significant predictors of postcarotid endarterectomy hyperperfusion development.
机译：背景：脑高灌注综合征是一种罕见但可能严重的颈动脉血运重建并发症，在术后顽固性高血压和脑血管自动调节受损的情况下发生。目的：确定哪些术前和手术因素影响颈动脉内膜切除术后大脑高灌注综合征的发展。方法：这项前瞻性观察研究纳入了93例接受颈动脉内膜切除术的无症状患者。经颅多普勒超声显示术后大脑中动脉平均血流增加100%的患者出现脑过度灌注。脑高灌注综合征是在术后出现至少一种症状的脑高灌注患者中诊断出来的。采用多元二元logistic回归分析术前和术后脑高灌注综合征的危险因素。结果：93例手术患者中，23例出现脑高灌注，18例出现脑高灌注综合征。脑高灌注综合征的危险因素包括在二元逻辑回归模型中。3D TOF磁共振图像上威利斯环形态不完整（p=0.002）、屏气指数低于0.69临界值（p=0.006）、TCD记录的威利斯环侧支循环流量不足的阳性标准（p=0.03）和高血压控制不良（p=0.023）对脑高灌注综合征具有统计学意义的独立预测价值。该模型具有统计学意义（p=0.012），并正确分类了90.3%的患者。结论：Willis环不完整、侧支循环不足、脑血管储备不足、高血压调节不良是颈动脉内膜切除术后高灌注发展的重要预测因素。

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