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Prediction of Cerebral Hyperperfusion Syndrome with Velocity Blood Pressure Index
Zhi-Chao Lai, Bao Liu, Yu Chen
1Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China.
Insights
A new Velocity BP Index (VBI) more accurately predicts cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy (CEA) by combining middle cerebral artery velocity and blood pressure changes. This improved prediction aids in preventing this serious complication.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Cerebral hyperperfusion syndrome (CHS) is a significant complication following carotid endarterectomy (CEA).
- Current prediction methods using middle cerebral artery velocity (MCAV) increase post-CEA have limited accuracy.
- Postoperative blood pressure (BP) increase is a known risk factor for CHS, but not previously used for prediction.
Purpose of the Study:
- To develop a more precise parameter for predicting CHS after CEA.
- To combine MCAV and BP changes to improve CHS risk prediction.
- To compare the predictive accuracy of the new parameter against existing methods.
Main Methods:
- Systolic MCAV and BP were recorded preoperatively and 30 minutes postoperatively.
- A novel Velocity BP Index (VBI) was calculated using the postoperative increase ratios of MCAV and BP.
- The predictive performance of VBI was compared to the velocity ratio (VR) for CHS occurrence.
Main Results:
- The VBI demonstrated superior predictive power for CHS compared to VR.
- At a cut-off of 2.0, VBI showed 83.3% sensitivity and 98.3% specificity for CHS.
- The area under the receiver operating characteristic curve for VBI (0.981) was significantly higher than for VR (0.935).
Conclusions:
- The Velocity BP Index (VBI) offers a more accurate prediction of CHS risk post-CEA.
- This new parameter can help identify patients requiring closer monitoring or intervention.
- Further validation in larger studies is recommended to confirm these findings.
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 limited. The increase in blood pressure (BP) after surgery is a risk factor of CHS, but no study uses it to predict CHS. This study was to create a more precise parameter for prediction of CHS by combined the increase of MCAV and BP after CEA.
Methods:
Systolic MCAV measured by transcranial Doppler and systematic BP were recorded preoperatively; 30 min postoperatively. The new parameter velocity BP index (VBI) was calculated from the postoperative increase ratios of MCAV and BP. The prediction powers of VBI and the increase ratio of MCAV (velocity ratio [VR]) were compared for predicting CHS occurrence.
Results:
Totally, 6/185 cases suffered CHS. The 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 development. This 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: AUC(VBI) = 0.981, 95% confidence interval [CI] 0.949-0.995; AUC(VR) = 0.935, 95% CI 0.890-0.966, P = 0.02.
Conclusions:
The new parameter VBI can more accurately predict patients at risk of CHS after CEA. This observation needs to be validated by larger studies.
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