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Nakagawa I, Park H, Kotsugi M, Myouchin K, Takeshima Y, Matsuda R, Yamada S, Park YS, Nakase H. Hypocapnia Induced by Hyperventilation with Indocyanine Green Kinetics Detects the Effect of Staged Carotid Angioplasty to Avoid Hyperperfusion in Patients with Impaired Cerebral Hemodynamic Reserve. Transl Stroke Res 2021; 13:77-87. [PMID: 33959854 DOI: 10.1007/s12975-021-00911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Cerebral hyperperfusion syndrome (CHS) is a serious complication following carotid artery stenting (CAS). Staged angioplasty (AP) could potentially prevent CHS and hyperperfusion phenomenon (HPP) after revascularization. However, methods for measuring the effects of staged AP on cerebral hemodynamic reserve have not been established. Here, we evaluated whether indocyanine green kinetics and near-infrared spectroscopy (ICG-NIRS) with hypocapnia induced by hyperventilation can detect the effects of staged AP on hemodynamic reserve to prevent CHS after CAS. Participants comprised 44 patients at high risk of CHS, whose ipsilateral cerebrovascular reactivity (CVR) was impaired on preoperative single photon emission computed tomography (SPECT). Patients were divided into a staged AP group (n=13) and a regular CAS group (n=31). In the staged AP group, stenting was performed 3 weeks after staged AP. In the regular CAS group, 16 cases (52%) showed HPP, and five (16%) presented with CHS after CAS, while no HPP or CHS occurred in the staged AP group (p=0.001). Changes in blood flow index (BFI) and time to peak (TTP) ratio during hypocapnia calculated from ICG-NIRS indicated a significant linear relationship with preprocedural CVR on SPECT (r=-0.710, 0.632, respectively; p<0.0001 each). BFI and TTP ratios during hypocapnia were significantly improved after staged AP (p<0.001 each). Furthermore, significant linear correlations were observed between BFI and TTP ratio during hypocapnia and postoperative asymmetry index AI (r=0.405, -0.475, respectively; p<0.01 each). Hypocapnia induced by hyperventilation under ICG-NIRS appears useful for detecting the effects of staged AP on hemodynamic reserve in patients at high risk of CHS.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - HunSoo Park
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kaoru Myouchin
- Department of Radiology, Nara Medical University, Nara, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Shuichi Yamada
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Young-Soo Park
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Burbridge MA, Jaffe RA. Paradoxical Critical Hyperkalemia After Acetazolamide for Cerebrovascular Reactivity Study: A Case Report. A A Pract 2020; 14:69-71. [PMID: 31770135 DOI: 10.1213/xaa.0000000000001148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the case of a 42-year-old man with moyamoya disease presenting for cerebral revascularization surgery who developed critical hyperkalemia following a single intravenous (iv) dose of 1000 mg of acetazolamide 1 day preoperatively for a cerebrovascular reactivity study. His potassium increased from 5.1 to 6.7 mmol/L. Prompt treatment of this abnormality allowed this patient to undergo surgery the next day uneventfully. A paradoxical, critical increase in potassium can result from a single 1000-mg iv dose of acetazolamide.
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Affiliation(s)
- Mark A Burbridge
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Nakagawa I, Yokoyama S, Wajima D, Nishimura F, Yamada S, Yokota H, Motoyama Y, Park YS, Wada T, Kichikawa K, Nakase H. Hyperventilation and breath-holding test with indocyanine green kinetics predicts cerebral hyperperfusion after carotid artery stenting. J Cereb Blood Flow Metab 2019; 39:901-912. [PMID: 29148891 PMCID: PMC6501514 DOI: 10.1177/0271678x17743878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cerebral hyperperfusion syndrome (CHS) is a serious complication following carotid artery stenting (CAS), but definitive early prediction of CHS has not been established. Here, we evaluated whether indocyanine green kinetics and near-infrared spectroscopy (ICG-NIRS) with hyperventilation (HV) and the breath-holding (BH) test can predict hyperperfusion phenomenon after CAS. The blood flow index (BFI) ratio during HV and BH was prospectively monitored using ICG-NIRS in 66 patients scheduled to undergo CAS. Preoperative cerebrovascular reactivity (CVR) and the postoperative asymmetry index (AI) were also assessed with single-photon emission computed tomography before and after CAS and the correlation with the BFI HV/rest ratio, BFI BH/rest ratio was evaluated. Twelve cases (18%) showed hyperperfusion phenomenon, and one (1.5%) showed CHS after CAS. A significant linear correlation was observed between the BFI HV/rest ratio, BFI BH/rest ratio, and preoperative CVR. A significant linear correlation was observed between the BFI HV/rest ratio and postoperative AI (r = 0.674, P < 0.0001). A BFI HV/rest ratio of 0.88 or more was the optimal cut-off point to predict hyperperfusion phenomenon according to receiver operating characteristic curve analyses. HV and BH test under ICG-NIRS is a useful tool for detection of hyperperfusion phenomenon in patients who underwent CAS.
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Affiliation(s)
- Ichiro Nakagawa
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shohei Yokoyama
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Daisuke Wajima
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | | | - Shuichi Yamada
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroshi Yokota
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Yasushi Motoyama
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Young Su Park
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Takeshi Wada
- 2 Department of Radiology, Nara Medical University, Nara, Japan
| | | | - Hiroyuki Nakase
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
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Ono Y, Morifusa M, Ikeda S, Kunishige C, Tohma Y. A case of non-cardiogenic pulmonary edema provoked by intravenous acetazolamide. Acute Med Surg 2017; 4:349-352. [PMID: 29123889 PMCID: PMC5674460 DOI: 10.1002/ams2.279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/12/2017] [Indexed: 11/09/2022] Open
Abstract
Case A 61‐year‐old man was diagnosed with severe chest trauma after a car accident and had had difficulty in weaning from a ventilator because of flail chest and dilated cardiomyopathy. On the 17th day in the intensive care unit, he received i.v. acetazolamide to increase urine output. One hour after the injection, he suddenly developed severe hypoxia. Chest radiography revealed a butterfly shadow. He received other diuretics and a vasodilator, which seemed slowly to resolve the respiratory failure. Five days later, acetazolamide was again given and he experienced the same deterioration. Outcome We concluded that the episodes were attributed to pulmonary edema provoked by acetazolamide. Conclusion Acute non‐cardiogenic pulmonary edema is an uncommon and lethal adverse effect of acetazolamide. Careful attention may be warranted when administering acetazolamide to critically ill patients.
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Affiliation(s)
- Yuichiro Ono
- Hyogo Prefectural Kakogawa Medical Center Kakogawa Hyogo Japan
| | - Makiko Morifusa
- Hyogo Prefectural Kakogawa Medical Center Kakogawa Hyogo Japan
| | - Satoru Ikeda
- Hyogo Prefectural Kakogawa Medical Center Kakogawa Hyogo Japan
| | - Chika Kunishige
- Hyogo Prefectural Kakogawa Medical Center Kakogawa Hyogo Japan
| | - Yoshiki Tohma
- Hyogo Prefectural Kakogawa Medical Center Kakogawa Hyogo Japan
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