Tsuyoshi Ohta1, Ichiro Nakahara2, Shoji Matsumoto3, Ryota Ishibashi3, Haruka Miyata3, Hidehisa Nishi3, Sadayoshi Watanabe2, Izumi Nagata3. 1. Department of Neurosurgery, Kochi Health Sciences Center, Kochi City, Kochi Prefecture, Japan. 2. Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake City, Aichi Prefecture, Japan. 3. Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka Prefecture, Japan.
Abstract
BACKGROUND: Definitive preoperative predictors of cerebral hyperperfusion following carotid artery stenting are yet to be established. OBJECTIVE: To determine the preprocedural risk factors for cerebral hyperperfusion phenomenon (CHP) following carotid artery stenting. METHODS: Patients undergoing preprocedural single-photon emission computed tomography (SPECT) and cerebral angiography prior to their first carotid artery stenting were monitored for occurrence of CHP. In addition to patient characteristics, we investigated imaging parameters, such as cerebral blood flow, cerebral vasoreactivity, and asymmetry index on SPECT, and presence of near occlusion and leptomeningeal anastomosis on cerebral angiography. RESULTS: Out of 100 patients (mean age: 73.0 ± 7.6 years; 85 men), 9 developed CHP. On multivariate logistic regression analysis, asymmetry index (%) on SPECT (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.70-0.93, P = .003) and presence of leptomeningeal anastomosis on cerebral angiography (OR 72.1, 95% CI 3.52-1480, P = .006) were independent predictors of CHP. CONCLUSION: Combined use of cerebral angiography and SPECT may obviate the need for acetazolamide challenge to predict the risk of CHP following carotid artery stenting.
BACKGROUND: Definitive preoperative predictors of cerebral hyperperfusion following carotid artery stenting are yet to be established. OBJECTIVE: To determine the preprocedural risk factors for cerebral hyperperfusion phenomenon (CHP) following carotid artery stenting. METHODS:Patients undergoing preprocedural single-photon emission computed tomography (SPECT) and cerebral angiography prior to their first carotid artery stenting were monitored for occurrence of CHP. In addition to patient characteristics, we investigated imaging parameters, such as cerebral blood flow, cerebral vasoreactivity, and asymmetry index on SPECT, and presence of near occlusion and leptomeningeal anastomosis on cerebral angiography. RESULTS: Out of 100 patients (mean age: 73.0 ± 7.6 years; 85 men), 9 developed CHP. On multivariate logistic regression analysis, asymmetry index (%) on SPECT (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.70-0.93, P = .003) and presence of leptomeningeal anastomosis on cerebral angiography (OR 72.1, 95% CI 3.52-1480, P = .006) were independent predictors of CHP. CONCLUSION: Combined use of cerebral angiography and SPECT may obviate the need for acetazolamide challenge to predict the risk of CHP following carotid artery stenting.