Amplitude of Tissue Oxygenation Index Change Predicts Cerebral Hyperperfusion Syndrome during Carotid Artery Stenting.

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Amplitude of Tissue Oxygenation Index Change Predicts Cerebral Hyperperfusion Syndrome during Carotid Artery Stenting.

World Neurosurg. 2016 Dec 22;:

Authors: Park HS, Nakagawa I, Yokoyama S, Motoyama Y, Park YS, Wada T, Kichikawa K, Nakase H

Abstract
OBJECTIVE: Hyperperfusion syndrome (HPS) following carotid artery stenting (CAS) is a rare but serious complication. HPS is associated with preoperative hemodynamic impairment due to poor collateral flow and intraoperative cerebral ischemia. Filter-type embolic protection devices (EPDs) maintain anterograde carotid flow during CAS and somewhat prevent HPS. Early treatment of patients undergoing CAS and at risk for HPS is essential. Near-infrared spectroscopy (NIRS) allows non-invasive, 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 EPD. Patients were retrospectively divided into good (n = 110) and poor/no cross flow groups (n = 20), and we compared the amplitude of the TOI change, correlation with ipsilateral regional cerebral blood flow, and clinical results.
RESULTS: The HPS incidence was significantly higher in the poor/no cross flow group (P = 0.019). In two patients with HPS, the amplitude of the TOI change was V-shaped, with a decrease after post-dilatation and an increase above baseline 5 minutes after reperfusion. The TOI/baseline ratio was significantly decreased after internal carotid artery occlusion for post-dilatation in the ipsilateral hemisphere in the poor/no cross flow 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 NIRS was an excellent predictor of cerebral HPS after CAS.

PMID: 28017753 [PubMed - as supplied by publisher]

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