Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Staged carotid artery angioplasty and stenting for patients with high-grade carotid stenosis with high risk of developing hyperperfusion injury: a retrospective analysis of 44 cases
First author：Dapeng Mo,Gang Luo
Corresponding author：Zhongrong Miao
essential_information
- Person in charge：Dapeng Mo,Gang Luo
- Data Sources： OTHERS
- Number of papers：OTHERS20190138
- Published time：2016-11-04
2016-11-04
Published articles
Journal：Stroke and Vascular Neurology
Publication type: Original Contributions
IF(IF): 4.081
PMID: 28959477 Link To Pubmed Full text Download
Background And Purpose
Hyperperfusion syndrome (HPS) is a rare but potentially a life-threatening complication aftercarot id artery angioplasty and stenting (CAS). Staged CAS has been an alternative to prevent HPS.
Method
44 of 908 patients with high-grade internal carotid artery stenosis or near occlusion were at risk of HPS because of poor collateral flow and impaired cerebral blood flow (CBF). They were treated with first (stage 1), followed by a full CAS (stage 2) 1 month later. Their 30-day outcomes were tabulated and analysed.
Conclusion
Staged carotid artery stenting probably decreased the chance of developing HPS in this group of selected patients. Although requiring a 2-step intervention, staged CAS may be a safe and effective alternative.
Main results
During follow-up, 1 of the 44 (2.2%) patients developed HPS immediately, 3 (7%) had postprocedural HPS (ie, transcranial Doppler (TCD) >120%) without clinical symptoms and 3 (7%) required stenting at stage 1 for carotid dissections. After stage 1, there were significant improvement between the preprocedural and postprocedural CBF (0.98±0.06 vs 0.85±0.05, p<0.05), mean transit time (MTT; 1.05±0.05 vs 1.15±0.05, p<0.05), time to peak (TTP; 1.04±0.06 vs 1.20±0.06, p<0.05) on CT perfusion (CTP), and CBF (66.41±7.41 vs 44.44±6.43, p<0.05) on TCD. After stage 2, improvement was seen in CBF (1.01±0.07 vs 0.98±0.06, p<0.05), MTT (1.01 ±0.05 vs 1.05±0.05, p<0.05), TTP (0.99±0.06 vs 1.04 ±0.06, p<0.05) on CTP and CBF (66.41±7.41 vs 93.78 ±18.81, p<0.05) on TCD. 2 had postoperative increase of middle cerebral artery mean flow velocity of 120% after stage 2 without clinical symptoms.