• Kohkichi Hosoda, Tetsuro Kawaguchi, Kazunari Ishii, Satoshi Minoshima, Yuji Shibata, Masaki Iwakura, Shigeo Ishiguro, and Eiji Kohmura.
• Department of Neurosurgery, Hyogo Brain and Heart Center, Himeji, Japan. khosoda@venus.dti.ne.jp
• Stroke. 2003 May 1; 34 (5): 1187-93.

Background And PurposeHyperperfusion syndrome is a rare but disastrous complication after carotid endarterectomy (CEA). The aim of this study was to investigate the relationship between preoperative cerebral blood flow (CBF) abnormalities and postoperative hyperperfusion through the use of statistical brain mapping analysis.MethodsFor 41 patients with unilateral carotid stenosis >or=70%, CBF and cerebral vasoreactivity (CVR) were investigated with resting and acetazolamide-challenge single photon emission CT before CEA. CBF 1 day after CEA was also measured. Three-dimensional stereotactic surface projection (3D-SSP) analysis of CBF changes was performed by use of a control database of 20 subjects.ResultsPatients with reduced CVR (CVR <10%, n=15) were categorized into 2 groups based on the severity of CBF reduction relative to the control database by 3D-SSP analysis without normalization: type I (ipsilateral CBF decrease <20%, n=8) and type II (ipsilateral CBF decrease >or=20%, n=7). With thalamic normalization, the patients were also categorized into 2 groups: type A (ipsilateral Z score 2, n=5). Severe CBF reduction (>or=20% or Z score >2) was significantly associated with postoperative hyperperfusion (CBF increase >or=100%). However, 3D-SSP with thalamic normalization (Z score) demonstrated a higher predictive value (80%) and specificity (91%) for hyperperfusion than 3D-SSP without normalization (percent reduction) (57% and 73%, respectively). No patients with normal CVR (CVR >or=10%, n=26) demonstrated postoperative hyperperfusion.ConclusionsObjective evaluation of abnormalities of CBF and CVR with 3D-SSP could identify patients at risk for postoperative hyperperfusion.

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