Next Article in Journal
Fibroblast-Derived Extracellular Matrix Induces Chondrogenic Differentiation in Human Adipose-Derived Mesenchymal Stromal/Stem Cells in Vitro
Next Article in Special Issue
Diabetes and Hypertension Consistently Predict the Presence and Extent of Coronary Artery Calcification in Symptomatic Patients: A Systematic Review and Meta-Analysis
Previous Article in Journal
Suppression of Lipid Accumulation by Indole-3-Carbinol Is Associated with Increased Expression of the Aryl Hydrocarbon Receptor and CYP1B1 Proteins in Adipocytes and with Decreased Adipocyte-Stimulated Endothelial Tube Formation
Previous Article in Special Issue
Mutant LRP6 Impairs Endothelial Cell Functions Associated with Familial Normolipidemic Coronary Artery Disease
Article

Cerebral Hyperperfusion after Revascularization Inhibits Development of Cerebral Ischemic Lesions Due to Artery-to-Artery Emboli during Carotid Exposure in Endarterectomy for Patients with Preoperative Cerebral Hemodynamic Insufficiency: Revisiting the “Impaired Clearance of Emboli” Concept

1
Department of Neurosurgery, School of Medicine, Iwate Medical University, 19-1 Uchmaru, 020-8505 Morioka, Japan
2
Cyclotron Research Center, School of Medicine, Iwate Medical University, 19-1 Uchmaru, 020-8505 Morioka, Japan
*
Author to whom correspondence should be addressed.
Academic Editor: Michael Henein
Int. J. Mol. Sci. 2016, 17(8), 1261; https://0-doi-org.brum.beds.ac.uk/10.3390/ijms17081261
Received: 1 June 2016 / Revised: 25 July 2016 / Accepted: 25 July 2016 / Published: 3 August 2016
(This article belongs to the Special Issue Atherosclerosis and Vascular Imaging 2016)
The purpose of the present study was to determine whether cerebral hyperperfusion after revascularization inhibits development of cerebral ischemic lesions due to artery-to-artery emboli during exposure of the carotid arteries in carotid endarterectomy (CEA). In patients undergoing CEA for internal carotid artery stenosis (≥70%), cerebral blood flow (CBF) was measured using single-photon emission computed tomography (SPECT) before and immediately after CEA. Microembolic signals (MES) were identified using transcranial Doppler during carotid exposure. Diffusion-weighted magnetic resonance imaging (DWI) was performed within 24 h after surgery. Of 32 patients with a combination of reduced cerebrovascular reactivity to acetazolamide on preoperative brain perfusion SPECT and MES during carotid exposure, 14 (44%) showed cerebral hyperperfusion (defined as postoperative CBF increase ≥100% compared with preoperative values), and 16 (50%) developed DWI-characterized postoperative cerebral ischemic lesions. Postoperative cerebral hyperperfusion was significantly associated with the absence of DWI-characterized postoperative cerebral ischemic lesions (95% confidence interval, 0.001–0.179; p = 0.0009). These data suggest that cerebral hyperperfusion after revascularization inhibits development of cerebral ischemic lesions due to artery-to-artery emboli during carotid exposure in CEA, supporting the “impaired clearance of emboli” concept. Blood pressure elevation following carotid declamping would be effective when embolism not accompanied by cerebral hyperperfusion occurs during CEA. View Full-Text
Keywords: artery-to-artery embolism; carotid endarterectomy; cerebral hemodynamic insufficiency; cerebral hyperperfusion; ischemic lesion artery-to-artery embolism; carotid endarterectomy; cerebral hemodynamic insufficiency; cerebral hyperperfusion; ischemic lesion
Show Figures

Graphical abstract

MDPI and ACS Style

Fujimoto, K.; Matsumoto, Y.; Oikawa, K.; Nomura, J.-i.; Shimada, Y.; Fujiwara, S.; Terasaki, K.; Kobayashi, M.; Yoshida, K.; Ogasawara, K. Cerebral Hyperperfusion after Revascularization Inhibits Development of Cerebral Ischemic Lesions Due to Artery-to-Artery Emboli during Carotid Exposure in Endarterectomy for Patients with Preoperative Cerebral Hemodynamic Insufficiency: Revisiting the “Impaired Clearance of Emboli” Concept. Int. J. Mol. Sci. 2016, 17, 1261. https://0-doi-org.brum.beds.ac.uk/10.3390/ijms17081261

AMA Style

Fujimoto K, Matsumoto Y, Oikawa K, Nomura J-i, Shimada Y, Fujiwara S, Terasaki K, Kobayashi M, Yoshida K, Ogasawara K. Cerebral Hyperperfusion after Revascularization Inhibits Development of Cerebral Ischemic Lesions Due to Artery-to-Artery Emboli during Carotid Exposure in Endarterectomy for Patients with Preoperative Cerebral Hemodynamic Insufficiency: Revisiting the “Impaired Clearance of Emboli” Concept. International Journal of Molecular Sciences. 2016; 17(8):1261. https://0-doi-org.brum.beds.ac.uk/10.3390/ijms17081261

Chicago/Turabian Style

Fujimoto, Kentaro, Yoshiyasu Matsumoto, Kohki Oikawa, Jun-ichi Nomura, Yasuyoshi Shimada, Shunrou Fujiwara, Kazunori Terasaki, Masakazu Kobayashi, Kenji Yoshida, and Kuniaki Ogasawara. 2016. "Cerebral Hyperperfusion after Revascularization Inhibits Development of Cerebral Ischemic Lesions Due to Artery-to-Artery Emboli during Carotid Exposure in Endarterectomy for Patients with Preoperative Cerebral Hemodynamic Insufficiency: Revisiting the “Impaired Clearance of Emboli” Concept" International Journal of Molecular Sciences 17, no. 8: 1261. https://0-doi-org.brum.beds.ac.uk/10.3390/ijms17081261

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop