カワシマ　アキツグ   Akitsugu Kawashima   川島　明次    所属   医学部 医学科（東京女子医科大学病院）    職種   准教授
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Incidence and predictive factors of cerebral hyperperfusion after extracranial-intracranial bypass for occlusive cerebrovascular diseases.
掲載誌名	正式名：Neurosurgery 略　 称：Neurosurgery ISSNコード：15244040/0148396X
掲載区分	国外
巻・号・頁	67(6),pp.1548-54; discussion 1554
著者・共著者	Yamaguchi Kohji, Kawamata Takakazu, Kawashima Akitsugu, Hori Tomokatsu, Okada Yoshikazu
発行年月	2010/12
概要	BACKGROUND:Although many studies of postoperative cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy have been reported, there are few reports related to extracranial-intracranial (EC-IC) bypass for atherosclerotic occlusive cerebrovascular diseases.OBJECTIVE:To examine the incidence of cerebral hyperperfusion and CHS after EC-IC bypass and to investigate predictive factors.METHODS:Fifty consecutive patients undergoing EC-IC bypass for atherosclerotic occlusive cerebrovascular diseases were studied. Immediately after bypass surgery, resting regional cerebral blood flow was determined under continuous sedation, and postoperative hyperperfusion was evaluated according to the definitions as follows: >50% increase in regional cerebral blood flow compared with the contralateral side (method 1) and>100% increase in corrected regional cerebral blood flow compared with preoperative values (method 2). Logistic regression analysis was conducted to determine the effect of multiple variables on postoperative hyperperfusion.RESULTS:Transient symptoms of CHS were observed in 3 patients. Cerebral hyperperfusion was detected in 12 patients (24%) as defined by method 1 and in 9 patients (18%) by method 2. Postoperative hyperperfusion occurred significantly more frequently in patients with the steal phenomenon (regional cerebral vasoreactivity≤0%; P=.001 by method 1 and P=.001 by method 2) and correlated with impaired preoperative regional cerebral vasoreactivity (P<.001). Logistic regression analysis revealed that the steal phenomenon was a significant risk factor for hyperperfusion as defined by both methods 1 (P=.009) and 2 (P=.03).CONCLUSION:The incidence of cerebral blood flow-assessed postoperative hyperperfusion after EC-IC bypass for atherosclerotic occlusive cerebrovascular diseases was not rare. Post EC-IC bypass CHS could be reduced by continuous, strict blood pressure control under sedation.
DOI	10.1227/NEU.0b013e3181f8c554
PMID	21107186