Intraprocedural Prediction of Hemorrhagic Cerebral Hyperperfusion Syndrome After Carotid Artery Stenting

2013 ◽  
Vol 22 (5) ◽  
pp. 615-619 ◽  
Author(s):  
Sumito Narita ◽  
Hiroshi Aikawa ◽  
Shun-ichi Nagata ◽  
Masanori Tsutsumi ◽  
Kouhei Nii ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Cerebral Hyperperfusion Syndrome ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion

Abstract W P115: Utilization of Blood Sampling Global Oxygen Extraction Fraction and SPECT to Anticipate Cerebral Hyperperfusion Syndrome Following Elective Carotid Artery Stenting

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Takahisa Mori ◽  
Tomonori Iwata ◽  
Yuhei Tanno ◽  
Shigen Kasakura ◽  
Yoshinori Aoyagi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Blood Sampling ◽  
Oxygen Extraction Fraction ◽  
Oxygen Extraction ◽  
Cerebral Hyperperfusion Syndrome ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Arterial Blood ◽  
Extraction Fraction

Background: It is required to anticipate cerebral hyperperfusion syndrome (CHS) following carotid artery stenting (CAS). Purpose: The purpose of our retrospective study was to investigate whether or not blood sampling oxygen extraction fraction (OEF) and post-CAS CBF increase in SPECT had relation to CHS following CAS. Methods: Included in our analysis were patients (1) who underwent elective CAS in our institution between October 2010 and May 2014, and (2) who underwent blood sampling for OEF calculation before and immediately after CAS, and (3) who underwent SPECT before and just after CAS. OEF was calculated from cerebral arteriovenous oxygen difference. Arterial blood was sampled from the common carotid artery and venous blood from the dominant-sided superior jugular bulb. CHS was defined as pulsatile headaches, restlessness, convulsion, and/or new neurological symptoms not due to cerebral ischemia within seven days following CAS. CBF was measured before and just after CAS. CBF increase in the CAS side was defined as follows; (post-CAS CBF ratio - pre-CAS CBF ratio) of more than 10%, where CBF ratio was defined as CAS-sided fronto-parietal CBF divided by ipsilateral cerebellar CBF (%). Evaluated were baseline features in patients, pre-CAS OEF, post-CAS OEF, CBF ratio, CBF increase and CHS. Results: During the study period, 134 patients matched our criteria for analysis. Pre-CAS OEF was 0.41+-0.06, post-CAS OEF was 0.42+-0.08, pre-CAS CBF ratio: 88.7+-15.4%, CBF increase: 1.86+-12.3%. Nine patients presented CHS. Among them, pre-CAS OEF, CBF ratio and CBF increase were significant. ROC curves showed that pre-CAS OEF of 0.46 (p<0.001, OR: 9.3), CBF ratio of 92%(p<0.05, OR: 6.5), CBF increase of 8.8% (p<0.005, OR: 6.6) were cut-off values. Among 10 patients with pre-CAS OEF of more than 0.46 and CBF increase of more than 8.8%, 4 patients presented CHS (p<0.0001, OR;15.9). Conclusion: Elevation of pre-CAS OEF and increase of post-CAS CBF were strongly related to CHS.

Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients

2007 ◽  
Vol 107 (6) ◽  
pp. 1130-1136 ◽  
Author(s):  
Kuniaki Ogasawara ◽  
Nobuyuki Sakai ◽  
Terumasa Kuroiwa ◽  
Kohkichi Hosoda ◽  
Koji Iihara ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Intracranial Hemorrhage ◽  
Carotid Artery Stenting ◽  
Clinicopathological Features ◽  
Cerebral Hyperperfusion Syndrome ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Postoperative Control

Object Intracranial hemorrhage associated with cerebral hyperperfusion syndrome (CHS) following carotid endarterectomy (CEA) or carotid artery stenting (CAS) is a rare but potentially devastating complication. In the present study the authors evaluated 4494 patients with carotid artery stenosis who had undergone CEA or CAS to clarify the clinicopathological features and outcomes of those with CHS and associated intracranial hemorrhage. Methods Patients with postoperative CHS were retrospectively selected, and clinicopathological features and outcomes were studied. Results Sixty-one patients with CHS (1.4%) were identified, and intracranial hemorrhage developed in 27 of them (0.6%). The onset of CHS peaked on the 6th postoperative day in those who had undergone CEA and within 12 hours in those who had undergone CAS. Results of logistic regression analysis demonstrated that poor postoperative control of blood pressure was significantly associated with the development of intracranial hemorrhage in patients with CHS after CEA (p = 0.0164). Note, however, that none of the tested variables were significantly associated with the development of intracranial hemorrhage in patients with CHS after CAS. Mortality (p = 0.0010) and morbidity (p = 0.0172) rates were significantly higher in patients with intracranial hemorrhage than in those without. Conclusions Cerebral hyperperfusion syndrome after CEA and CAS occurs with delayed classic and acute presentations, respectively. Although strict control of postoperative blood pressure prevents intracranial hemorrhage in patients with CHS after CEA, there appears to be no relationship between blood pressure control and intracranial hemorrhage in those with CHS after CAS. Finally, the prognosis of CHS in patients with associated intracerebral hemorrhage is poor.

Global Oxygen Extraction Fraction by Blood Sampling to Anticipate Cerebral Hyperperfusion Phenomenon After Carotid Artery Stenting

Neurosurgery ◽  
2014 ◽  
Vol 75 (5) ◽  
pp. 546-551 ◽  
Author(s):  
Tomonori Iwata ◽  
Takahisa Mori ◽  
Yuichi Miyazaki ◽  
Yuhei Tanno ◽  
Shigen Kasakura ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Blood Sampling ◽  
Oxygen Extraction Fraction ◽  
Cerebral Hyperperfusion Syndrome ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Extraction Fraction

Abstract BACKGROUND: Cerebral hyperperfusion syndrome sometimes occurs after carotid revascularization in patients with severe hemodynamic failure. To prevent cerebral hyperperfusion syndrome, cerebral hyperperfusion phenomenon (CHP) must be detected early. Single-photon emission computed tomography (SPECT) is useful for detecting CHP, but it is impractical on a daily basis. A tool with high availability to find CHP is desired. OBJECTIVE: To investigate whether global oxygen extraction fraction (OEF) by a blood sampling method is useful for indicating CHP after carotid artery stenting (CAS). METHODS: When patients underwent elective CAS from September 2010 to August 2012, we performed blood sampling for OEF calculation and SPECT before and immediately after elective CAS. Data were collected prospectively. OEF was calculated from the cerebral arteriovenous oxygen difference. Cerebral blood flow was measured in the affected middle cerebral artery (MCA) territory and in the ipsilateral cerebellum by SPECT. The ratio of MCA to cerebellar activity was defined as cerebral blood flow in the affected MCA territory divided by cerebral blood flow in the ipsilateral cerebellar hemisphere. Probable CHP was defined as ≥10% increase in the ratio of MCA to cerebellar activity after CAS. The relationship between peri-CAS OEF and probable CHP was evaluated. RESULTS: Of the 96 patients enrolled, 92 patients were analyzed. Probable CHP occurred in 17 patients. Post-CAS OEF was related to probable CHP (P &lt; .01), but pre-CAS OEF was not. The receiver-operating characteristic curve showed that the cutoff value was 45% for probable CHP (P &lt; .001). CONCLUSION: An increase in blood sampling OEF immediately after CAS was related to probable CHP; then the oxygen demand should be reduced.

Abstract WP129: Nationwide Questionnaire Survey of Carotid Artery Stenting for Patients at High Risk for Cerebral Hyperperfusion Syndrome

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Mikito Hayakawa ◽  
Yuji Matsumaru ◽  
Nobuyuki Sakai ◽  
Hiroshi Yamagami ◽  
Koji Iihara ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Questionnaire Survey ◽  
Carotid Artery Stenting ◽  
Single Stage ◽  
Cerebral Hyperperfusion Syndrome ◽  
High Risk Patients ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Risk Patients

Background and purpose: Cerebral hyperperfusion syndrome (CHS) including intracranial hemorrhage (ICH) is a serious complication after carotid artery stenting (CAS). Therefore, in Japan, neuroendovascular physicians commonly evaluate the CHS risk of the CAS candidates using various pre-procedural imaging tests and sometimes perform preventive procedures against CHS, such as staged angioplasty (SAP; balloon angioplasty with an undersized balloon followed by delayed CAS) reported by Yoshimura et al. We conducted a nationwide questionnaire survey to clarify the current status of pre-procedural evaluation of the CHS risk and outcomes of high-risk patients of CHS who underwent CAS (including SAP) in Japan. Methods: Questionnaires were mailed to neuroendovascular therapy experts certified by the Japanese society in June 2014, regarding imaging tests to evaluate the CHS risk and the total number of the patients who underwent CAS with or without 30-day adverse event (CHS, ICH, stroke or death) between October 2007 and March 2014. Results: Responses were obtained from 154 institutes enrolling 363 experts (35.3% of all the certified experts). Pre-procedural imaging tests to evaluate the CHS risk were introduced in 144 institutes (93.5%) and single photon emission CT (SPECT) was mostly used in 88.2% of the institutes. A total of 7114 patients (7470 lesions) who underwent CAS with pre-procedural imaging tests was registered, including 1269 high-risk patients of CHS (1305 lesions, 17.5%). The rates of CHS and ICH in the high-risk patients were significantly higher than those of the non-high-risk patients (6.0% vs 0.4% [p<0.01] and 3.1% vs 0.3% [p<0.01], respectively). SAP was performed in 184 high-risk patients (189 lesions, 14.5%). SAP tended to reduce CHS (6.5% to 3.2%, p=0.08) of high-risk patients although modestly increase ischemic stroke (3.2 to 4.2%, p=0.51). The composite stroke or death rate of the SAP group was not different from that of the single-stage CAS group (6.1% vs 5.8%, p=0.88). Conclusion: Most of the CAS candidates were stratified according to the CHS risk by SPECT in Japan, and CHS was developed in 6.5% of the high-risk patients who underwent single-stage CAS and in 3.2% of those who underwent SAP. To prove the efficacy of SAP, further study is needed.

Sign in / Sign up

Export Citation Format

Share Document