Impaired Dynamic Cerebral Autoregulation as a Predictor for Cerebral Hyperperfusion After Carotid Endarterectomy: A Prospective Observational Study

• Published in: World neurosurgery 2024-01, Vol.181, p.e312-e321
• Main Authors: Li, Na, Zhou, Fubo, Lu, Xia, Chen, Hongxiu, Liu, Ran, Chen, Songwei, Xing, Yingqi
• Format: Article
• Language: English
• Subjects: Carotid endarterectomy; Cerebral autoregulation; Cerebral hyperperfusion; Hemodynamics; Transcranial Doppler ultrasound
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2023.10.046

Cerebral hyperperfusion syndrome (CHS) is a severe complication of carotid endarterectomy (CEA). Because cerebral hyperperfusion (CH) reduces the benefits of CEA, it is important to identify patients at high risk of developing CH. We investigated dynamic cerebral autoregulation (dCA) as a potential predictor of CH after CEA. In a prospective observational study of 90 patients, we defined CH as a ≥100% increase in the transcranial Doppler ultrasound-derived mean flow velocity of the middle cerebral artery compared to baseline, with or without clinical manifestations. We examined dCA in the supine position and during squat-stand maneuvers using the transfer function, analyzing phase, gain, and coherence. Logistic regression analysis and receiver operating characteristic (ROC) curves were used to assess the relationships between variables and outcomes. Cerebral hyperperfusion (CH) occurred in 18 patients after CEA. The CH group had a lower ipsilateral phase for both body postures than the non-CH group at very low and low frequencies, respectively (both P