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.

Abstract TP123: Efficacy of Staged Angioplasty to Prevent Cerebral Hyperperfusion Syndrome After Endovascular Revascularization for Carotid Artery Stenosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mikito Hayakawa ◽  
Tomohito Hishikawa ◽  
Kenji Sugiu ◽  
Hiroshi Yamagami ◽  
Nobuyuki Sakai ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Cumulative Incidence ◽  
Emission Computed Tomography ◽  
Cerebral Hyperperfusion Syndrome ◽  
High Risk Patients ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Risk Patients ◽  
Event Rates

Background and aim: Cerebral hyperperfusion syndrome (CHS) including intracranial hemorrhage (ICH) is a serious complication after carotid artery stenting (CAS). Staged angioplasty (SAP), undersized-balloon angioplasty followed by delayed CAS, was reported to be a potential preventable method against CHS. The aim of this study was to clarify the efficacy of SAP to prevent CHS after endovascular carotid revascularization for high-risk patients of CHS. Methods: The STOP CHS study is a multicenter, retrospective study which registered 535 high-risk patients of CHS from 45 Japanese centers, who underwent regular CAS, SAP or angioplasty performed by board-certified neurointerventionists between October 2007 and March 2014. Selection of high-risk patients of CHS was based on imaging tests, such as single-photon emission computed tomography with acetazolamide. We investigated the cumulative periprocedural rates of CHS, ICH and major adverse event (MAE: stroke, myocardial infarction and death) of patients scheduled for regular CAS or SAP (intention-to-treat [ITT] population) and the relationship between SAP and the cumulative incidence of CHS in ITT and as-treated (AT) populations (patients who underwent regular CAS or SAP). Results: A total of 525 patients (532 lesions, 74 women, 72.5±7.5 years old) was included. Angiographic stenosis was 86.2±9.2% and 337 lesions were symptomatic. Scheduled procedures were regular CAS in 419 lesions and SAP in 113 lesions, and final procedures were regular CAS in 428 lesions, SAP in 102 lesions and angioplasty in 2 lesions. The cumulative event rates were CHS in 9.2%, ICH in 4.3% and MAE in 11.5%, and these were higher in patients scheduled for regular CAS than in patients scheduled for SAP(10.5 % vs 4.4%, 5.3% vs 0.9% and 12.9% vs 6.2% with each p-value <0.05, respectively). After multivariate adjustment, schedule for SAP was negatively related to the cumulative incidence of CHS (OR, 0.25; 95%CI, 0.09-0.73). Same applied to implementation of SAP in AT population (OR, 0.28; 95%CI, 0.10-0.82). Conclusion: The cumulative periprocedural event rates of high-risk patients of CHS scheduled for regular CAS or SAP were actually high. SAP was a negative predictor of CHS in both ITT and AT populations.

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.

Carotid artery stenting with routine cerebral protection in high-risk patients

2004 ◽  
Vol 188 (6) ◽  
pp. 644-652 ◽  
Author(s):  
Peter H. Lin ◽  
Ruth L. Bush ◽  
Dieter F. Lubbe ◽  
Mitchell M. Cox ◽  
Wei Zhou ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Artery Stenting ◽  
Cerebral Protection ◽  
High Risk Patients ◽  
Risk Patients

Outcomes of carotid artery stenting in high-risk patients; a single center retrospective review

2012 ◽  
Vol 54 (4) ◽  
pp. 289
Author(s):  
Ahmet Kirbas ◽  
Nursen Tanrikulu ◽  
Mutlu Cihangiroglu ◽  
Omer Isik
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Retrospective Review ◽  
Carotid Artery Stenting ◽  
Single Center ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Postoperative ischemic events in patients undergoing carotid artery stenting using algorithmic selection for embolic protection

2019 ◽  
Vol 32 (4) ◽  
pp. 294-302 ◽  
Author(s):  
Yasuhiro Kawabata ◽  
Norio Nakajima ◽  
Hidenori Miyake ◽  
Shunichi Fukuda ◽  
Tetsuya Tsukahara
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Transient Ischemic Attack ◽  
Carotid Artery Stenting ◽  
Minor Stroke ◽  
High Risk Patients ◽  
Embolic Protection ◽  
Risk Patients ◽  
Ischemic Attack

Purpose Carotid artery stenting (CAS) is a valuable alternative to carotid endarterectomy, especially in high-risk patients. However, the reported incidences of perioperative stroke and death remain higher than for carotid endarterectomy, even when using embolic protection devices (EPDs) during CAS. Our purpose was to evaluate 30-day major adverse events after CAS when selecting the most appropriate EPD. Methods We reviewed the clinical outcomes of 61 patients with 64 lesions who underwent CAS with EPDs. Patients who underwent CAS associated with thrombectomy and who had a preoperative modified Rankin scale score >3 were excluded from the analysis. The EPD was selected based on symptoms, carotid wall magnetic resonance imaging and lesion length, and we analyzed combined 30-day complication rates (transient ischemic attack, minor stroke, major stroke or death). Results Forty-nine patients were men and 12 were women. The median age was 72 years (range: 59–89 years) and 44 lesions were asymptomatic. A filter-type EPD was selected in 23 procedures, distal-balloon protection in 14 procedures and proximal-occlusive protection in 27 procedures. Two patients (3.1%) experienced a transient ischemic attack and one patient (1.6%) had a minor stroke within 30 days of the procedure. No patients experienced procedure-related morbidities (modified Rankin score >2) or death. Conclusions The perioperative stoke rate was low when we selected a proximal-occlusive-type EPD in high-risk patients with vulnerable carotid artery disease. Our algorithm for EPD selection was an effective tool in the perioperative management of carotid artery stenosis.

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