Clinical study of cerebral hyperperfusion following carotid endarterectomy according to transcranial Doppler ultrasonography monitoring

摘要

Objective To investigate clinical features of cerebral hyperperfusion following carotid endarterectomy (CEA), and to explore the effect of treating cerebral hyperperfusion following CEA according to transcranial Doppler ultrasonography (TCD) monitoring. Methods Sixty-three CEAs were performed under general anesthesia from January to August 2013 and TCD monitoring was performed during the surgery. Carotid shunts were applied on the basis of TCD monitoring. Cerebral hyperperfusion and cerebral hyperperfusion syndrome (CHS) following CEA were determined and treated according to perioperative TCD monitoring. Results Postoperative three-dimensional CTA confirmed that carotid artery stenosis was released in all of those patients. During 30 d after CEA, one patient (1.59%) suffered mild ischemic stroke, one patient (1.59%) myocardial infarction, and one patient (1.59%) hoarseness. There was no cases of cerebral hemorrhage or death. Four patients (6.35%) suffered cerebral hyperperfusion following CEA, lasting for 1-3 d, and among them one patient (1.59%) suffered CHS, the clinical symptoms of which included excitement, hallucination and sleep disorder. In 3 cases (4.76% ), postoperative visual acuity improved significantly, and among them one patient suffered cerebral hyperperfusion. Conclusions TCD monitoring could detect intraoperative and postoperative cerebral hyperperfusion early. On the basis of TCD monitoring, blood pressure control is the key for reducing postoperative intracranial hemorrhage.doi：10.3969/j.issn.1672-6731.2014.01.007Video: http://www.cjcnn.org/index.php/cjcnn/pages/view/v14n1a7.