Prediction of hyperperfusion phenomenon after carotid artery stenting and carotid angioplasty using quantitative DSA with cerebral circulation time imaging

BackgroundHyperperfusion syndrome after carotid interventions has a low incidence but it can lead to morbidity and mortality.ObjectiveTo evaluate the usefulness of quantitative DSA for predicting hyperperfusion phenomenon (HPP) after carotid artery stenting and angioplasty.MethodsThirty-three consecutive patients with carotid stenosis treated with carotid artery stenting or angioplasty between February 2014 and August 2016 were included. Color-coded digital subtraction angiograms showing the time to maximum contrast intensity of each image pixel were obtained from conventional DSA before and after procedures. The cerebral circulation time (CCT) was defined as the difference in the relative time to maximum intensity between arterial and venous regions of interest set on the angiograms. HPP was diagnosed straight after the procedure with qualitative 123I-IMP single-photon emission CT (SPECT). Cut-off points for detecting HPP for preprocedural CCT and periprocedural change of CCT were assessed by receiver operating characteristic analysis using 123I-IMP SPECT as reference standard.Results123I-IMP SPECT showed HPP in 4 of 33 patients. In these 4 patients, preprocedural prolongation of CCT (13.0±6.1 vs 7.2±1.3 s; p<0.001) was seen compared with patients without HPP as well as larger periprocedural changes of CCT (5.9±5.7 vs 0.5±1.3 s; p<0.001). The optimal cut-off points of preprocedural CCT and change of CCT for predicting HPP were 8.0 s (100% sensitivity, 69% specificity) and 3.2 s (75% sensitivity, 100% specificity), respectively.ConclusionsPreprocedural prolongation and greater periprocedural change of CCT are associated with the occurrence of HPP. Periprocedural evaluation of CCT may be useful for predicting HPP.

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Intraprocedural Changes in Angiographic Cerebral Circulation Time Predict Cerebral Blood Flow After Carotid Artery Stenting

Neurologia medico-chirurgica ◽

10.2176/nmc.50.269 ◽

2010 ◽

Vol 50 (4) ◽

pp. 269-274 ◽

Cited By ~ 13

Author(s):

Hiroshi AIKAWA ◽

Kiyoshi KAZEKAWA ◽

Masanori TSUTSUMI ◽

Masanari ONIZUKA ◽

Minoru IKO ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Cerebral Circulation ◽

Carotid Artery Stenting ◽

Circulation Time ◽

Cerebral Circulation Time

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Single-photon emission computed tomography and transcranial color-coded real-time sonography studies can predict hyperperfusion syndrome after carotid artery stenting

Cerebral Blood Flow and Metabolism (Japanese journal of cerebral blood flow and metabolism) ◽

10.16977/cbfm.26.2_173 ◽

2015 ◽

Vol 26 (2) ◽

pp. 173-176

Author(s):

Tomonori Iwata

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Real Time ◽

Carotid Artery Stenting ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Single Photon Emission ◽

Single Photon Emission Computed ◽

Photon Emission Computed Tomography

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Angiographic Cerebral Circulation Time Before and After Endovascular Therapy for Symptomatic Vasospasm

Clinical Radiology ◽

10.1053/crad.2000.0507 ◽

2000 ◽

Vol 55 (9) ◽

pp. 679-683 ◽

Cited By ~ 13

Author(s):

T. ISEDA ◽

S. NAKANO ◽

T. YONEYAMA ◽

T. IKEDA ◽

T. MORIYAMA ◽

...

Keyword(s):

Endovascular Therapy ◽

Cerebral Circulation ◽

Circulation Time ◽

Symptomatic Vasospasm ◽

Before And After ◽

Cerebral Circulation Time

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Prolonged cerebral circulation time is more associated with symptomatic carotid stenosis than stenosis degree or collateral circulation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2017-013293 ◽

2017 ◽

Vol 10 (5) ◽

pp. 476-480 ◽

Cited By ~ 2

Author(s):

Yong-Sin Hu ◽

Wan-Yuo Guo ◽

I-Hui Lee ◽

Feng-Chi Chang ◽

Chung-Jung Lin ◽

...

Keyword(s):

Carotid Stenosis ◽

Cerebral Circulation ◽

Collateral Circulation ◽

Stroke Risk ◽

Circulation Time ◽

High Grade ◽

Symptomatic Carotid ◽

Symptomatic Carotid Stenosis ◽

The Difference ◽

Cerebral Circulation Time

Background and purposeCurrent practice of revascularization for carotid stenosis (CS) primarily relies on symptoms and degree of stenosis. Other parameters, such as collateral circulation and cerebral circulation time (CCT), might influence the stroke risk in CS. This study was conducted to (1) investigate whether CCT is more associated with symptomatic CS than degree of stenosis and (2) elucidate the associations among the degree of stenosis, collateral status, and CCT.MethodsFrom 2010 to 2016, 82 patients with unilateral CS were enrolled for DSA and divided into symptomatic and asymptomatic groups based on clinical presentation. CCT was defined as the difference between the time taken by the cavernous internal carotid artery and parietal vein to reach the maximal contrast medium intensities on lateral DSA. The degree of stenosis, collateral status, and CCT of the two groups were compared. Logistic regression analysis was performed to estimate the OR for symptomatic CS with the imaging variables.ResultsThe symptomatic group had a significantly higher degree of stenosis and longer CCT. CCT (OR 1.95, p=0.013) was more associated with symptomatic CS than the degree of stenosis (OR 1.03, p=0.229), after adjustment for potential confounders—namely, age, sex, antithrombotic use, and collateral status. Symptomatic high grade CS with collaterals had a non-significantly shorter CCT than those without collaterals.ConclusionsDSA derived CCT is more reflective of the hemodynamic differences between symptomatic and asymptomatic CS than degree of stenosis. Collaterals may not effectively reduce CCT in symptomatic high grade CS.

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Prediction of intracranial hemorrhage after carotid artery stenting using preprocedural single-photon emission computed tomography

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.300 ◽

2017 ◽

Vol 381 ◽

pp. 90

Author(s):

M. Hayakawa ◽

K. Kajimoto ◽

K. Sugiu ◽

S. Yoshimura ◽

T. Hishikawa ◽

...

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Intracranial Hemorrhage ◽

Carotid Artery Stenting ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Single Photon Emission ◽

Single Photon Emission Computed ◽

Photon Emission Computed Tomography

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Reduced cerebrovascular reserve is associated with an increased risk of postoperative ischemic lesions during carotid artery stenting

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2014-011163 ◽

2014 ◽

Vol 8 (6) ◽

pp. 576-580 ◽

Cited By ~ 7

Author(s):

Masaomi Koyanagi ◽

Kazumichi Yoshida ◽

Yoshitaka Kurosaki ◽

Nobutake Sadamasa ◽

Osamu Narumi ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenting ◽

Single Photon ◽

Photon Emission ◽

Multivariate Logistic Regression Analysis ◽

Black Blood ◽

Plaque Imaging ◽

Cerebrovascular Reserve ◽

Increased Risk ◽

Significant Difference

BackgroundReduced cerebrovascular reserve (CVR) is associated with increased risk of ischemic events in carotid steno-occlusive diseases.ObjectiveTo determine whether pretreatment CVR can predict postoperative ischemic lesions after carotid artery stenting (CAS) by retrospective analysis.MethodsWe retrospectively reviewed the medical records of 46 patients (42 men; mean age 74.2±8.3 years) who underwent CAS and preprocedural cerebral blood flow measurement by quantitative single-photon emission CT. Ischemic lesions were evaluated by diffusion-weighted image (DWI) within 72 h after the intervention. We also evaluated plaque characteristics using black-blood MR plaque imaging.ResultsNew ipsilateral DWI-positive lesions were found in 11 cases (23.9%). Patients were classified into two groups based on the presence or absence of new DWI-positive lesions, and no significant differences in characteristics were found between the DWI-positive and DWI-negative groups, except for age and CVR of the ipsilateral middle cerebral artery (MCA) territory. The DWI-positive group was significantly older than the DWI-negative group (79.7±4.1 vs 72.5±8.6 years; p=0.0085) and had lower average regional CVR (1.4±18.2% vs 22.4±25.8%; p=0.016). MR plaque imaging showed no significant difference in relative overall plaque MR signal intensity between the two groups (1.53±0.37 vs 1.34±0.26; p=0.113). In multivariate logistic regression analysis, lower CVR of the ipsilateral MCA territory (<11%) was the only independent risk factor for new ischemic lesions following CAS (OR=6.99; 95% CI 1.17 to 41.80; p=0.033).ConclusionsImpaired pretreatment CVR was associated with increased incidence of new infarction after CAS.

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Hemichorea due to hemodynamic ischemia associated with extracranial carotid artery stenosis

Journal of Neurosurgery ◽

10.3171/jns.2006.105.1.142 ◽

2006 ◽

Vol 105 (1) ◽

pp. 142-147 ◽

Cited By ~ 13

Author(s):

Ryoma Morigaki ◽

Masaaki Uno ◽

Atsuhiko Suzue ◽

Shinji Nagahiro

Keyword(s):

Carotid Artery ◽

Carotid Artery Stenosis ◽

Single Photon ◽

Photon Emission ◽

Internal Carotid Artery Stenosis ◽

Artery Stenosis ◽

Emission Computed Tomography ◽

Vascular Reserve ◽

Limb Shaking ◽

Photon Emission Computed Tomography

✓ In this paper the authors describe two patients with recurrent hemiparesis and limb shaking that gradually progressed to hemichorea. Cerebral angiography confirmed severe unilateral internal carotid artery stenosis (95%) contra-lateral to the hemichorea. The cerebral blood flow, assessed using N-isopropyl-p-(iodine-123) iodoamphetamine single-photon emission computed tomography (SPECT), disclosed markedly decreased vascular reserves in both patients. After carotid endarterectomy was performed, the hemichorea gradually subsided and SPECT confirmed increased cerebral perfusion. The results in these cases indicate that surgical revascularization is effective for hemichorea due to cerebral ischemia with reduced vascular reserve.

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