Diagnostic Impact of Transcranial Color-Coded Real-Time Sonography With Echo Contrast Agents for Hyperperfusion Syndrome After Carotid Endarterectomy

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Abstract
Background and Purpose— The purpose of the present study was to evaluate availability of transcranial color-coded real-time sonography (TCCS) to detect hyperperfusion after carotid endarterectomy (CEA). Methods— This prospective study included 105 consecutive patients who underwent CEA for severe carotid stenosis. TCCS with echo contrast agents was performed serially to evaluate flow velocity of the middle cerebral artery (MCA). Regional cerebral blood flow (rCBF) and vasodilatory capacity of the MCA territory were evaluated using single-photon emission computed tomography. We compared the changes in MCA flow velocity with rCBF. Results— Using echo contrast agents, we could evaluate the MCA flow in 95 (90%) of 105 patients. Twelve patients showed hyperperfusion syndrome. Changes in the MCA mean flow velocity (MFV) before and 4 days after CEA were significantly correlated with those in rCBF (r=0.48; P50% in MCA MFV was observed within 4 days after CEA in all 12 patients with hyper...