Abstract 2355: 2d Perfusion Color Mapping Can Predict Hyperperfusion Syndrome After Carotid Artery Stenting

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ryo Yoshimura ◽  
Yuko Tanaka ◽  
Kenichi Kono ◽  
Hideo Okada ◽  
Takeshi Fujimoto ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Cerebral Perfusion ◽  
Neurological Deficits ◽  
High Morbidity ◽  
Color Mapping ◽  
Hyperperfusion Syndrome ◽  
Symptomatic Vasospasm ◽  
Before And After

Background: Hyperperfusion syndrome (HPS) is one of the most important complications during carotid artery stenting (CAS), which presents headache, seizure, focal neurological deficits due to intracerebral hemorrhage. It is essential to predict HPS because of its high morbidity or mortality. 2D perfusion color mapping (2DPCoM) enables to clarify cerebral perfusion status using only digital subtraction angiography (DSA) and its workstations. We report 2DPCoM can predict HPS. Materials and Methods: 778 patients who had performed CAS have registered. All of the patients were analyzed with SPECT before and after CAS, including acetazolamide study. Transcranial doppler (TCD) have been performed before, during, and after CAS if possible. HPS was defined neurological deficits and intracerebral or subarachnoid hemorrhage with CT or MRI. DSA was performed with Allura Xper FD20/10 (Philips). 2DPCoM was analyzed with 6ml/sec contrast medium infusion from common carotid artery for 1 second. Maximum enhancement, start to peak, average wash-in rate (AWR) , Area-under-curve (AUC), mean transit time (MTT) were revealed. The data were compared with SPECT and TCD. Results: 6/778 cases have presented HPS. All of the patients manifested misery perfusion (Powers stage 2) before CAS with SPECT. Mean middle cerebral artery flow velocity markedly increased after CAS with SPECT. 2DPCoM showed remarkable hyperperfusion state after CAS, especially MTT. MTT of all HPS cases dramatically changed >25% before and after the procedure. Discussion: 2DPCoM has a lot of potential for evaluating cerebral hemodynamics with great ease compared with SPECT or TCD. It needs no more devices or drugs, needs only ‘one injection, one click, and one minute’. It might be useful for intracranial percutaneous transluminal angioplasty/stenting, symptomatic vasospasm following subarachnoid hemorrhage, and some other hemodynamic diseases. Conclusion: 2D perfusion color mapping requires only one more infusion. It needs no more devices and one-click analysis within less than 1 minute. It is very useful modality during CAS for analyzing cerebral perfusion status.

Positron Emission Tomographic Cerebral Perfusion Disturbances and Transcranial Doppler Findings among Patients with Neurological Deterioration after Subarachnoid Hemorrhage

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1017-1024 ◽  
Author(s):  
Pawan S. Minhas ◽  
David K. Menon ◽  
Piotr Smielewski ◽  
Marek Czosnyka ◽  
Peter J. Kirkpatrick ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Cerebral Perfusion ◽  
Internal Carotid ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Neurological Deficits ◽  
Positron Emission Tomographic ◽  
Positron Emission ◽  
Arterial Vasospasm ◽  
The Mean

Abstract OBJECTIVE After aneurysmal subarachnoid hemorrhage, approximately 30% of patients experience delayed neurological deficits, related in part to arterial vasospasm and dysautoregulation. Transcranial Doppler (TCD) ultrasonography is commonly used to noninvasively detect arterial vasospasm. We studied cerebral perfusion patterns and associated TCD indices for 25 patients who developed clinical signs of delayed neurological deficits. METHODS Patients were treated in a neurosurgical intensive care unit and were studied if they exhibited delayed focal or global neurological deterioration. Positron emission tomographic cerebral blood flow (CBF) studies and TCD studies measuring the mean flow velocity (FV) of the middle cerebral artery and the middle cerebral artery FV/internal carotid artery FV ratio (with the internal carotid artery FV being measured extracranially at the cranial base) were performed. Glasgow Outcome Scale scores were assessed at 6 months. RESULTS A markedly heterogeneous pattern of CBF distribution was observed, with hyperemia, normal CBF values, and reduced flow being observed among patients with delayed neurological deficits. TCD indices were not indicative of the cerebral perfusion findings. The mean CBF value was slightly lower for patients who did not survive (32.3 ml/100 g/min), compared with those who did survive (36.0 ml/100 g/min, P= 0.05). CONCLUSION Among patients who developed delayed neurological deficits after aneurysmal subarachnoid hemorrhage, a wide range of cerebral perfusion disturbances was observed, calling into question the traditional concept of large-vessel vasospasm. Commonly used TCD indices do not reflect cerebral perfusion values.

Cerebral hyperperfusion syndrome resulting in subarachnoid hemorrhage after carotid artery stenting

2016 ◽  
Vol 30 (9) ◽  
pp. 669-674 ◽  
Author(s):  
Makoto Isozaki ◽  
Yoshikazu Arai ◽  
Yoshifumi Higashino ◽  
Hidehiko Okazawa ◽  
Ken-ichiro Kikuta
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Cerebral Hyperperfusion Syndrome ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion

Staged angioplasty: A sensible approach to prevent hyperperfusion syndrome after carotid artery stenting? A meta-analysis

2021 ◽  
pp. 159101992110183
Author(s):  
Bingyang Zhao ◽  
Xinzhao Jiang ◽  
Pei Wang ◽  
Zhongyu Zhao ◽  
Jing Mang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Meta Analysis ◽  
Random Effect ◽  
Thromboembolic Events ◽  
Current Recommendation ◽  
Hyperperfusion Syndrome ◽  
Asian Populations ◽  
Significant Difference ◽  
Vessel Dissection

Objective To investigate whether staged angioplasty (SAP) is a safe and effective treatment to prevent hyperperfusion syndrome after carotid artery stenting (CAS). Methods A systematic literature search was performed according to established criteria to identify eligible articles published before October 2020. Pooled dichotomous data were presented as odds ratios (OR) and corresponding 95% confidence intervals (CI) using random-effect models. The efficacy endpoints were hyperperfusion syndrome (HPS), hyperperfusion phenomenon (HPP), and intracerebral hemorrhage (ICH). The safety endpoint was post-procedural thromboembolic events. The feasibility of the procedure was assessed by device-related adverse events (vessel dissection and failed angioplasty) in SAP. Results Ten studies (1030 participants) were eligible. SAP was superior to regular CAS in preventing HPS (OR = 0.35, 95% CI 0.14–0.86, P = 0.02). There was no significant difference in the rate of thromboembolic events between the SAP group and the regular CAS group. The rates of vessel dissection and failed angioplasty with the use of a 3.0-mm-diameter balloon were 5.4% and 0.4%, respectively. Conclusion SAP may reduce the incidence of post-CAS HPS without increasing procedure-related complications. A 3.0-mm-diameter balloon used in SAP may be appropriate for Asian populations. However, the confounded study design and confused definitions of reporting items hinder the current recommendation of SAP in clinical use.

Hyperperfusion Syndrome: Toward a Stricter Definition

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1053-1060 ◽  
Author(s):  
◽  
Shelagh B. Coutts ◽  
Michael D. Hill ◽  
William Y. Hu ◽  
Garnette R. Sutherland
Keyword(s):  
Carotid Artery ◽  
Intracerebral Hemorrhage ◽  
Carotid Endarterectomy ◽  
Clinical Presentation ◽  
Imaging Techniques ◽  
Neurological Deficits ◽  
Acute Hemorrhage ◽  
Motor Weakness ◽  
Hyperperfusion Syndrome ◽  
Angioplasty And Stenting

Abstract OBJECTIVE Hyperperfusion syndrome is a rare and potentially devastating complication of carotid endarterectomy or carotid artery angioplasty and stenting. With the advent of new imaging techniques, we reviewed our experience with this phenomenon. METHODS This report is a retrospective review of 129 consecutive cases of carotid endarterectomy performed between June 1, 2000, and May 31, 2002, and 44 consecutive cases of carotid artery angioplasty and stenting performed between January 1, 1997, and May 31, 2002. We specifically searched for examples of patients who developed postprocedural nonthrombotic neurological deficits that typified the hyperperfusion syndrome. RESULTS Seven cases of hyperperfusion syndrome occurred, four after endarterectomy (3.1% of carotid endarterectomy cases) and three after stenting (6.8% of stenting cases). The cases of hyperperfusion were classified as presenting with 1) acute focal edema (two cases with stroke-like presentation, attributable to edema immediately after revascularization), 2) acute hemorrhage (two cases of intracerebral hemorrhage immediately after stenting and one case immediately after endarterectomy), or 3) delayed classic presentation (two cases with seizures, focal motor weakness, and/or late intracerebral hemorrhage at least 24 hours after endarterectomy). CONCLUSION Hyperperfusion syndrome may be more common and more variable in clinical presentation than previously appreciated.

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.

scholarly journals Hyperperfusion syndrome after carotid artery stenting for repeated in-stent restenosis

Nosotchu ◽  
2021 ◽  
Author(s):  
Rika Inano ◽  
Ryohei Goda ◽  
Eiji Ogino ◽  
Ryosuke Nishi ◽  
Masaki Maeda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Hyperperfusion Syndrome ◽  
Stent Restenosis ◽  
In Stent Restenosis

scholarly journals Computed tomography indicators of cerebral microperfusion improve long term after carotid stenting in symptomatic patients

2019 ◽  
Author(s):  
Pawel J Winklewski ◽  
Mariusz Kaszubowski ◽  
Grzegorz Halena ◽  
Agnieszka Sabisz ◽  
Kamil Chwojnicki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Predictive Value ◽  
Carotid Artery Stenting ◽  
Ct Perfusion ◽  
Carotid Stenting ◽  
Cerebral Microcirculation ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Before And After

Objectives: We tested the hypothesis that computed tomography (CT) perfusion markers of cerebral microcirculation would improve 36 months after internal carotid artery stenting for symptomatic carotid stenosis while results obtained 6–8 weeks after the stenting procedure would yield a predictive value. Methods: We recruited consecutive eligible patients with >70% symptomatic carotid stenosis with a complete circle of Willis and normal vertebral arteries to the observational cohort study. We detected changes in the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and permeability surface area-product (PS) before and after carotid stenting. We have also compared the absolute differences in the ipsilateral and contralateral CT perfusion markers before and after stenting. The search for regression models of “36 months after stenting” results was based on a stepwise analysis with bidirectional elimination method. Results: A total of 34 patients completed the 36 months follow-up (15 females, mean age of 69.68±S.D. 7.61 years). At 36 months after stenting, the absolute values for CT perfusion markers had improved: CBF (ipsilateral: +7.76%, contralateral: +0.95%); CBV (ipsilateral: +5.13%, contralateral: +3.00%); MTT (ipsilateral: –12.90%; contralateral: –5.63%); TTP (ipsilateral: –2.10%, contralateral: –4.73%) and PS (ipsilateral: –35.21%, contralateral: –35.45%). MTT assessed 6–8 weeks after stenting predicted the MTT value 36 months after stenting (ipsilateral: R2=0.867, contralateral R2=0.688). Conclusions: We have demonstrated improvements in CT perfusion markers of cerebral microcirculation health that persist for at least 3 years after carotid artery stenting in symptomatic patients. MTT assessed 6–8 weeks after stenting yields a predictive value.

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