Author/Editor		Tetičkovič, Erih; Miksič, Kazimir
Title		Možganski hiperfuzijski sindrom med karotidno trombendarterektomijo in po njej
Translated title		Cerebral hyperperfusion syndrome during and after carotid thrombendarterectomy
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 69, št. 4
Publication year		2000
Volume		str. 237-40
Language		slo
Abstract		Background. Cerebral hyperperfusion syndrome (HPS) occurring during carotid thrombendarterectomy (TEA) or following it may represent a dangerous complication of surgical treatment of a hemodynamically significant stenosis of the internal carotid artery (ACI), particularly if it progresses to intracerebral hemorrhage. Transcranial Doppler ultrasonography (TCD) offers the possibility of following the changes in cerebral perfusion. Methods. ln 71 patients with hemodynamically significant stenosis of the ACI (> 75%), TCD sonography was used to follow the bloodflow velocity in the middle cerebral artery (MCA) on the side of operation prior to and during surgery, and throughout the following 24 hours. Results. Cerebral HPS was discovered in 14 cases: 2 during carotid TEA, 12 within the first 24 hours after surgery. All cases involve high-risk patients with a high degree of carotid stenosis, expressed and unstable arterial hypertension as well as destroyed autoregulation. Intracerebral hemorrhage occurred in one case. Conclusions. We find that high-risk patients are particularly exposed to the danger of cerebral HPS. Intraoperative and early postoperative TCD offer the possibility of early detection and treatment of cerebral HPS, thus decreasing morbidity and mortality on its account.
Summary		Izhodišča. Možganski hiperperfuzijski sindrom (HPS) med korotidno trombendarterektomijo (TEA) in po njej je lahko nevaren zaplet operativnega zdravljenja hemodinamsko pomembne stenoze notranje karotidne arterije (ACI), zlasti še, če privede do intracerebralne krvavitve. Transkranialna Dopplerjeva sonografija (TCD) omogoča spremljanje sprememb možganske perfuzije. Metode. Pri 71 bolnikih s hemodinamsko pomembno stenozo ACI (<75%) smo s TCD spremljali hitrosti krvnega pretoka v srednji možganski arteriji (MCA) na operirani strani pred operacijo, med njo ter prvih 24 ur po njej. Rezultati. Možganski HPS smo odkrili pri 14 bolnikih: dvakrat med karotidno TEA, 12-krat pa prvih 24 ur po operaciji. V vseh primerih je šlo za ogrožene bolnike z visoko stopnjo karotidne stenoze, izrazito in nestabilno arterijsko hipertenzijo ter porušeno cerebralno avtoregulacijo. Pri enem bolniku je prišlo do intracerebralne krvavitve. Zaključki. Ugotovimo, da je nevarnost možganskega HPS pri ogroženih bolnikih za ta sindrom zelo velika. Medoperativni in zgodnji pooperativni TCD dajeta možnost zgodnjega odkrivanja ter zdravljenja možganskega HPS, s tem pa tudi zmanjšanja zbolevnosti in smrtnosti zaradi njega.
Descriptors		CAROTID STENOSIS ENDARTERECTOMY, CAROTID ULTRASONOGRAPHY, DOPPLER, TRANSCRANIAL INTRAOPERATIVE COMPLICATIONS BLOOD FLOW VELOCITY CEREBRAL ARTERIES