頚部内頚動脈血行再建術後の過灌流症候群に対する治療─経時的transcranial color-coded sonography所見に基づいた血圧管理について─

Abstract

Purpose : The mean flow velocity of the middle cerebral artery (MCA-MFV) on transcranial color-coded sonography (TCCS) and blood pressure was monitored after carotid stenting (CAS) and carotid endarterectomy (CEA),and we investigated the correlation between MCA-MFV and mean blood pressure.Subjects and methods : Twenty patients who underwent CAS and CEA were studied. MCA-MFV using TCCS and blood pressure were monitored daily.Results : Two patients developed cerebral hyperperfusion syndrome (CHS). In CHS cases, the ipsilateral MCA-MFV showed a sudden 1. 7-fold increase in the early postoperative phase. and the ipsilateral MCA-MFV was correlated with mean blood pressure until l week (case 1) or 2 weeks (case 2) after surgery. Ipsilateral MCA-MFV and mean blood pressure then showed no correlation at 2 weeks (case 1) or 3 weeks (case 2) after surgery. In non-CHS cases, the ipsilateral MCA-MFV was stable and blood pressure-independent. In both CHS and non-CHS cases. contralateral MCA-MFV was stable and blood pressure-independent.Discussion : Changes in ipsilateral MCA-MFV and blood pressure appear to be related to transient dysfunction of auto-regulation. Strict blood pressure management should be maintained until the ipsilateral MCA-MFV becomes stable and independent of blood pressure.Conclusions : In the treatment of CHS, serial TCCS and blood pressure monitoring after CAS and CEA may be useful for management of blood pressure.