Abstract TP152: Computed Tomography Perfusion Parameter to Predict Cerebral Hyperperfusion Phenomenon Following Carotid Artery Stenting

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Yoichiro Takahashi ◽  
Takahisa Mori ◽  
Tomonori Iwata ◽  
Yuichi Miyazaki ◽  
Masahito Nakazaki ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Perfusion Parameter ◽  
Unaffected Side ◽  
Time To Peak ◽  
Cerebral Hyperperfusion ◽  
Ratio Change

Background: Although SPECT is useful for predicting and finding cerebral hyperperfusion phenomenon (CHP) following carotid artery stenting (CAS), there are few institutions that could perform SPECT during peri-CAS period. The purpose of our study is to evaluate whether or not parameters derived from CT perfusion (CTP) used widely can predict CHP. Methods: Patients who underwent CTP before elective CAS and SPECT before and immediately after elective CAS in our institution from December 2010 to May 2012. We defined CHP as post-CAS increase of more than 10% of the ratio of cerebral blood flow (CBF) in the territory of the affected middle cerebral artery (MCA) divided by CBF in the ipsilateral cerebellum (MCA/CE ratio) measured by SPECT. We assessed the correlation of pre-CAS CTP’s parameters’ ratio to MCA/CE ratio change between pre-CAS and post-CAS SPECT. The CTP’s parameters’ ratio was calculated as (parameters in the affected side divided by in the unaffected side). CTP parameters we assessed are as follows: time-to-peak (TTP), mean-transit-time (MTT), cerebral blood volume (CBV) and CBF. Results: Fifty patients were analyzed. Pre-CAS TTP ratio showed a significant positive correlation with MCA/CE ratio change (r = 0.2863, p = 0.044). Other parameters (MTT, CBV and CBF) had no significant correlation. The cut-off value of pre-CAS TTP ratio was 1.08 to predict CHP (AUC = 0.77859, p = 0.032). Conclusion: Increase of pre-CAS TTP ratio is probably correlated with CHP following elective CAS.

scholarly journals The effect of carotid artery stenting on capillary transit time heterogeneity in patients with carotid artery stenosis

2018 ◽  
Vol 3 (3) ◽  
pp. 263-271 ◽  
Author(s):  
Ethem M Arsava ◽  
Mikkel B Hansen ◽  
Berkan Kaplan ◽  
Ahmet Peker ◽  
Rahsan Gocmen ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Transit Time ◽  
Carotid Artery Stenting ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Oxygen Extraction Fraction ◽  
Consecutive Series ◽  
Dynamic Susceptibility ◽  
Dynamic Susceptibility Contrast ◽  
Vascular Events

Introduction Carotid revascularisation improves haemodynamic compromise in cerebral circulation as an additional benefit to the primary goal of reducing future thromboembolic risk. We determined the effect of carotid artery stenting on cerebral perfusion and oxygenation using a perfusion-weighted MRI algorithm that is based on assessment of capillary transit-time heterogeneity together with other perfusion and metabolism-related metrics. Patients and methods A consecutive series of 33 patients were evaluated by dynamic susceptibility contrast perfusion-weighted MRI prior to and within 24 h of the endovascular procedure. The level of relative change induced by stenting, and relationship of these changes with respect to baseline stenosis degree were analysed. Results Stenting led to significant increase in cerebral blood flow ( p < 0.001), and decrease in cerebral blood volume ( p = 0.001) and mean transit time ( p < 0.001); this was accompanied by reduction in oxygen extraction fraction ( p < 0.001) and capillary transit-time heterogeneity ( p < 0.001), but an overall increase in relative capillary transit-time heterogeneity (RTH: CTH divided by MTT; p = 0.008). No significant change was observed with respect to cerebral metabolic rate of oxygen. The median volume of tissue with MTT > 2s decreased from 24 ml to 12 ml ( p = 0.009), with CTH > 2s from 29 ml to 19 ml ( p = 0.041), and with RTH < 0.9 from 61 ml to 39 ml ( p = 0.037) following stenting. These changes were correlated with the baseline degree of stenosis. Discussion: Stenting improved the moderate stage of haemodynamic compromise at baseline in our cohort. The decreased relative transit-time heterogeneity, which increases following stenting, is probably a reflection of decreased functional capillary density secondary to chronic hypoperfusion induced by the proximal stenosis. Conclusion: Carotid artery stenting, is not only important for prophylaxis of future vascular events, but also is critical for restoration of microvascular function in the cerebral tissue.

scholarly journals Intraprocedural Detection of Cerebral Hyperperfusion by Flat Detector Computed Tomography in the Evaluation of Cerebral Blood Volume during Carotid Artery Stenting

2014 ◽  
Vol 20 (4) ◽  
pp. 502-509 ◽  
Author(s):  
Yukinori Terada ◽  
Taketo Hatano ◽  
Yasunori Nagai ◽  
Makoto Hayase ◽  
Masashi Oda ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Blood Volume ◽  
Carotid Artery Stenting ◽  
Cerebral Blood Volume ◽  
Present Report ◽  
Neurological Deficits ◽  
Flat Detector ◽  
Cerebral Hyperperfusion ◽  
Angiography Suite

Cerebral blood volume (CBV) can be measured using a C-arm flat detector angiographic system. The present report describes a case in which cerebral hyperperfusion was detected with the Neuro parenchymal blood volume (PBV) system (syngo Neuro PBV IR, Siemens Medical Solutions, Erlangen, Germany) during carotid artery stenting (CAS). An 89-year-old man was referred to our hospital for cerebral brain infarction and severe stenosis of the left carotid artery. CAS was performed, and Neuro PBV was used to measure CBV both during and after the procedure. Postoperative Neuro PBV revealed dramatically increased CBV, and a hyperperfusion state was suspected. The next day, subarachnoid hemorrhage along the sulcus of the left hemisphere was revealed on computed tomography. Strict management of blood pressure was instituted just after the detection of hyperperfusion, and the patient was ultimately discharged from the hospital without any new neurological deficits. Neuro PBV has the advantage that it can be performed in the angiography suite and does not require patient transfer to an alternate setting. Therefore, intracranial hemodynamic changes can be detected during the procedure. We conclude that the Neuro PBV system is useful for monitoring intracranial hemodynamics during endovascular procedures.

Evaluation of Cerebral Hyperperfusion After Carotid Artery Stenting Using C‑Arm CT Measurements of Cerebral Blood Volume

2016 ◽  
Vol 28 (2) ◽  
pp. 253-260 ◽  
Author(s):  
Michio Fujimoto ◽  
Hiroshi Itokawa ◽  
Masao Moriya ◽  
Noriyoshi Okamoto ◽  
Jinichi Sasanuma
Keyword(s):  
Carotid Artery ◽  
Blood Volume ◽  
Carotid Artery Stenting ◽  
Cerebral Blood Volume ◽  
Cerebral Hyperperfusion ◽  
Ct Measurements

scholarly journals Predictive Value of the Velocity of Collateral Filling in Patients with Acute Ischemic Stroke

2014 ◽  
Vol 35 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Sebastian E Beyer ◽  
Louisa von Baumgarten ◽  
Kolja M Thierfelder ◽  
Marietta Rottenkolber ◽  
Hendrik Janssen ◽  
...  
Keyword(s):  
Cerebral Blood Volume ◽  
Ct Perfusion ◽  
Mean Transit Time ◽  
Intravenous Thrombolysis ◽  
Lesion Size ◽  
Small Lesion ◽  
Time Resolved ◽  
Time To Peak ◽  
Magnetic Resonance Imaging Mri

The velocity of collateral filling can be assessed in dynamic time-resolved computed tomography (CT) angiographies and may predict initial CT perfusion (CTP) and follow-up lesion size. We included all patients with an M1± internal carotid artery (ICA) occlusion and follow-up imaging from an existing cohort of 1791 consecutive patients who underwent multimodal CT for suspected stroke. The velocity of collateral filling was quantified using the delay of time-to-peak (TTP) enhancement of the M2 segment distal to the occlusion. Cerebral blood volume (CBV) and mean transit time (MTT)-CBV mismatch were assessed in initial CTP. Follow-up lesion size was assessed by magnetic resonance imaging (MRI) or non-enhanced CT (NECT). Multivariate analyses were performed to adjust for extent of collateralization and type of treatment. Our study comprised 116 patients. Multivariate analysis showed a short collateral blood flow delay to be an independent predictor of a small CBV lesion ( P<0.001) and a large relative mismatch ( P<0.001) on initial CTP, of a small follow-up lesion ( P<0.001), and of a small difference between initial CBV and follow-up lesion size ( P=0.024). Other independent predictors of a small lesion on follow-up were a high morphologic collateral grade ( P=0.001), lack of an additional ICA occlusion ( P=0.009), and intravenous thrombolysis ( P=0.022). Fast filling of collaterals predicts initial CTP and follow-up lesion size and is independent of extent of collateralization.

scholarly journals Clinically Meaningful MRI Perfusion Abnormalities in Acute Stroke: Comparison of Analytic Techniques

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 339-339
Author(s):  
Chen-Sen Wu ◽  
Lawrence L Latour ◽  
Steven Warach
Keyword(s):  
At Risk ◽  
Acute Stroke ◽  
Moment Method ◽  
Cerebral Blood Volume ◽  
Mean Transit Time ◽  
Clinical Severity ◽  
Perfusion Parameter ◽  
Time Curve ◽  
Time To Peak ◽  
First Moment

P2 Background: MRI perfusion imaging (PWI) can demonstrate hemodynamic abnormalities in acute stroke. The volume of hypoperfusion derived from calculated perfusion parameter maps has been used to predict tissue at risk for infarction and to identify presumptive ischemic penumbra. It is unclear how best to distinguish true tissue at risk from benign hypoperfusion. A first step toward this goal is identifying clinically significant PWI abnormalities in stroke patients. Our purpose was to evaluate four different perfusion parameter maps to determine which algorithm best correlates with clinical severity. Methods: Twenty patients were retrospectively selected from our database. Selection criteria included 1) acute hemispheric lesion, 2) MRI within 24 hours of symptom onset, and 3) no history of prior stroke. Perfusion maps were derived using four different algorithms to estimate relative mean transit time (rMTT): 1) cerebral blood volume (CBV) / cerebral blood flow (CBF), 2) CBV / peak of the concentration-time curve, 3) time to peak (TTP), and 4) ratio of the 1 st / 0 th moment of the transfer function (first moment method). Abnormal perfusion volumes were derived from ever-increasing thresholds of rMTT delay relative to normal contralateral tissue. The volumes at each delay threshold were correlated with National Institutes of Health Stroke Scale (NIHSS) for each algorithm. Results: Significant correlations between hypoperfusion volumes and NIHSS were found for all algorithms. The first moment method had the highest correlation (r = 0.76) and the correlations for this method were independent of the delay threshold used to derive the volumes. For the other algorithms, the best correlations were observed for volumes including only voxels with delays of 4 seconds or greater. Conclusions: This analysis suggests that the first moment method may have advantages over the others in determining the correlation of hypoperfusion volume to NIHSS. Further analyses correlating acute hypoperfusion volumes to final infarct volumes may help refine the choice of best analytic method for determining clinically relevant PWI abnormalities.

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.

Risk factors for hyperperfusion-induced intracranial hemorrhage after carotid artery stenting in patients with symptomatic severe carotid stenosis evaluation

2018 ◽  
Vol 11 (5) ◽  
pp. 474-478 ◽  
Author(s):  
Lei Zhang ◽  
Dongwei Dai ◽  
Zifu Li ◽  
Guoli Duan ◽  
Yong-wei Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Carotid Stenosis ◽  
Intracranial Hemorrhage ◽  
Carotid Artery Stenting ◽  
Ct Perfusion ◽  
Treatment Strategies ◽  
Imaging Features ◽  
Anterior Circulation ◽  
Total Occlusion

BackgroundAnalyzing risk factors for hyperperfusion-induced intracranial hemorrhage (HICH) after carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis.MethodsThis study retrospectively analyzed clinical data of 210 patients, who had symptomatic severe carotid stenosis (70–99%) and received CAS treatment between June 2009 and June 2015, and evaluated the relationship of HICH with patients’ clinical baseline data, imaging features, and treatment strategies.ResultsSeven patients (3.3%) developed HICH after CAS. The incidence of HICH among patients with near total occlusion was significantly higher than among those without (10.1% vs 0%, P<0.001). Out of the seven, five had no development of either anterior or posterior circulations, and two had no development of anterior circulation and poor development of posterior circulation. Results showed that patients with poor compensation of Willis’ Circle were more likely to develop HICH compared with other patients (P<0.001). All patients received preoperative CT perfusion. TTP index was defined as the TTP ratio between the affected and contralateral side. The results showed that the TTP index was significantly different between the HICH group and non-HICH group (1.15±0.10 vs 1.30±0.15, P<0.001). An analysis of the ROC curve indicated that patients with TTP index >1.22 were more likely to develop HICH compared with other patients (sensitivity 100%, specificity 75.9%).ConclusionsPatients with severe unilateral carotid stenosis, the presence of near total occlusion, poor compensation of Willis’ Circle, and preoperative TTP index>1.22, have a higher risk of developing HICH after CAS.

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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