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Prediction of cerebral hyperperfusion syndrome with Velocity Blood Pressure Index

Chinese Medical Journal 2015年第12期128卷 1611-1617页

作者： Zhi-Chao Lai Bao Liu Yu Chen Leng Ni Chang-Wei Liu Department of Vascular Surgery Peking Union Medical College Hospital Chinese Academy of Medical Science Beijing 100730 China

Background：cerebral hyperperfusion syndrome is an important complication of carotid endarterectomy （CEA）.An 〉 100% increase in middle cerebral artery velocity （MCAV） after CEA is used to predict the cerebral hyperperfusion syndrome （CHS） development,but the accuracy is *** increase in blood pressure （BP） after surgery is a risk factor of CHS,but no study uses it to predict *** study was to create a more precise parameter for prediction of CHS by combined the increase of MCAV and BP after ***：Systolic MCAV measured by transcranial Doppler and systematic BP were recorded preoperatively;30 min *** new parameter velocity BP index （VBI） was calculated from the postoperative increase ratios of MCAV and BE The prediction powers of VBI and the increase ratio of MCAV （velocity ratio [VR]） were compared for predicting CHS ***：Totally,6/185 cases suffered *** best-fit cut-off point of 2.0 for VBI was identified,which had 83.3% sensitivity,98.3% specificity,62.5% positive predictive value and 99.4% negative predictive value for CHS *** result is significantly better than VR （33.3%,97.2%,28.6% and 97.8%）.The area under the curve （AUC） of receiver operating characteristic：AUCvBI =0.981,95% confidence interval [CI] 0.949-0.995;AUCvR =0.935,95% CI 0.890-0.966,P =***：The new parameter VBI can more accurately predict patients at risk of CHS after *** observation needs to be validated by larger studies.

关键词： Blood Pressure Carotid Endarterectomy cerebral hyperperfusion syndrome Prediction Transcranial Doppler

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Risk factors of postoperative cerebral hyperperfusion syndrome and its relationship with clinical prognosis in adult patients with moyamoya disease

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Chinese Neurosurgical Journal 2023年第3期9卷 190-198页

作者： Zhiyong Shi Lingyun Wu Yi Wang Huasheng Zhang Yongbo Yang Chunhua Hang Department of Neurosurgery Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNo.321 Zhongshan RoadNanjingJiangsu Province MN 210008People’s Republic of China

Background To investigate the incidence,risk factors,and clinical prognosis of cerebral hyperperfusion syndrome(CHS)after superficial temporal artery-middle cerebral artery anastomosis combined with encephalo-duro-arterio-synangiosis(STA-MCA/EDAS)in adult patients with moyamoya disease(MMD).Methods The clinical data of 160 adult patients with MMD treated by STA-MCA/EDAS from January 2016 to January 2017 were retrospectively *** to CHS diagnosis,MMD patients were divided into CHS and non-CHS *** and multivariate analysis of risk factors and Kaplan-Meier curve of stroke-free survival for CHS were *** A total of 12 patients(7.5%)developed postoperative CHS,of which 4 patients(2.5%)presented with cerebral *** and multivariate analysis showed moyamoya vessel on the surgical hemisphere(OR=3.04,95%CI=1.02-9.03,P=0.046)and left operated hemisphere(OR=5.16,95%CI=1.09-21.34,P=0.041)were independent risk factors for *** other variables,such as age,gender,presentation,hypertension,diabetes,smoking,mean mRS score on admission,modified Suzuki stage and pre-infarction stage on surgical hemisphere,and bypass patency,had no association with postoperative CHS(P>0.05).At final follow-up with average 38 months,there were 18 out of 133 patients(13.5%,4.91%per person year)presented with newly developed *** was no significant difference between newly developed complications,mean mRS scores,and Kaplan-Meier curve of stroke-free survival in patients with and without CHS(P>0.05).Conclusion The concentration of moyamoya vessels and left operated hemisphere was independent risk factors for CHS,which could not affect the clinical prognosis if treated timely and *** current study offers a new perspective of moyamoya vessels and supporting data for choosing MMD candidates on cerebral revascularization.

关键词： Moyamoya disease Combined cerebral revascularization cerebral hyperperfusion syndrome Risk factors Clinical prognosis

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Postoperative hemorrhage during the acute phase after direct or combined revascularization for moyamoya disease: risk factors, prognosis and literature review

Postoperative hemorrhage during the acute phase after direct...

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第十四届中国医师协会神经外科医师年会

作者： Yu Chen Li Ma Junlin Lu Xiaolin Chen Xun Ye Rong Wang Yuanli Zhao Department of Neurosurgery Beijing Tiantan HospitalCapital Medical University

Postoperative hemorrhage during the acute phase is rarely observed after the revascularization surgery for moyamoya disease（MMD） but have severe complications. Its risk factors and outcomes are still unclear. The aim of this study was to investigate the predictors of postoperative hemorrhage during the acute phase in MMD and examine the outcomes of the hemorrhage. Methods: The authors reviewed the preoperative clinical characteristics and radiographic features of 465 consecutive MMD cases（518 procedures） who underwent direct or combined bypass surgery in our institution between 2009 and 2015. Patients with postoperative intracerebral hemorrhage（ICH） or ICH + intraventricular hemorrhage（IVH） during the acute phase were screened, then the incidence, hemorrhage locations and risk factors of these patients were analyzed. Short-term and long-term outcomes（modified Rankin Scale [mRS]） for these patients were also collected. Outcomes were compared between patients who had postoperative ICH and those without postoperative ICH, using propensity-score analysis to reduce the between-group differences in the baseline characteristics. Results: Postoperative hemorrhage occurred in 11 cases from the 518 procedures（2.1%;mean age, 39.82±8.8 years;ICH=9, IVH=2）. 8 cases（72.7%） occurred hemorrhage in the first 24 hours after the operation. In the ICH group, most of the hemorrhage sites（77.8%） were located beneath the anastomosed area, and the mean hematoma volume was 16.98±22.45 ml（range 3-57 ml）. 1 case from the ICH group required hematoma evacuation. For the adult patients（463 procedures, 89.4%）, preoperative hypertension（P=0.005）, computed tomography perfusion（CTP） stage＞Ⅲ（P=0.043） and posterior circulation involvement（P=0.027） were significantly associated with postoperative ICH. No significant differences were detected between the postoperative ICH group and the no-hemorrhage group in postoperative neurofunctional status at discharge（P=0.569） and at the last follow-up（P=1.000）. T

关键词： Moyamoya disease Postoperative hemorrhage cerebral hyperperfusion syndrome Direct revascularization

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