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Please use this identifier to cite or link to this item: http://hdl.handle.net/10564/3675

Title: Amplitude of Tissue Oxygenation Index Change Predicts Cerebral Hyperperfusion Syndrome During Carotid Artery Stenting.
Other Titles: 頸動脈ステント留置術周術期における脳組織酸素化指数を用いた術後過灌流予測
Authors: Park, Hun Soo
Nakagawa, Ichiro
Yokoyama, Shohei
Motoyama, Yasushi
Park, Young Su
Wada, Takeshi
Kichikawa, Kimihiko
Nakase, Hiroyuki
Keywords: Carotid artery stenting
Hyperperfusion syndrome
Near-infrared spectroscopy
Issue Date: Mar-2017
Publisher: Elsevier
Citation: World neurosurgery Vol.99 p.548-555 (2017 Mar)
Abstract: OBJECTIVE: Hyperperfusion syndrome (HPS) after carotid artery stenting (CAS) is a rare but serious complication. HPS is associated with preoperative hemodynamic impairment as the result of poor collateral flow and intraoperative cerebral ischemia. Filter-type embolic protection devices maintain anterograde carotid flow during CAS and prevent HPS somewhat. The early treatment of patients undergoing CAS and at risk for HPS is essential. Near-infrared spectroscopy allows noninvasive, real-time measurement of frontal lobe regional cerebral O2 saturation (TOI; tissue oxygenation index). METHODS: The perioperative amplitude of TOI was monitored in 130 patients undergoing CAS while using a filter-type embolic protection device. Patients were divided retrospectively into good (n = 110) and poor/no crossflow groups (n = 20), and we compared the amplitude of the TOI change, correlation with ipsilateral regional cerebral blood flow, and clinical results. RESULTS: The incidence of HPS was significantly greater in the poor/no crossflow group (P = 0.019). In 2 patients with HPS, the amplitude of the TOI change was V-shaped, with a decrease after postdilatation and an increase above baseline 5 minutes after reperfusion. The TOI/baseline ratio was significantly decreased after internal carotid artery occlusion for postdilatation in the ipsilateral hemisphere in the poor/no crossflow group (P < 0.05). Significant linear correlations were observed between TOI/baseline ratio changes and preoperative cerebrovascular reactivity and the postoperative asymmetry index (r = -0.346, P = 0.002, r = 0.613, P < 0.001, respectively). CONCLUSIONS: The amplitude of the TOI change measured by near-infrared spectroscopy was an excellent predictor of cerebral HPS after CAS.
Description: 博士(医学)・乙第1439号・令和元年9月27日
Copyright © 2016 Elsevier Inc. All rights reserved.
URI: http://hdl.handle.net/10564/3675
ISSN: 18788750
Academic Degrees and number: 24601B1439
Degree-granting date: 2019-09-27
Degree name: 博士(医学)
Degree-granting institutions: 奈良県立医科大学
Appears in Collections:2019年度

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