Safety and efficacy of staged angioplasty for patients at risk of hyperperfusion syndrome: a single-center retrospective study

Autor: Kenji Sugiu, Yoko Yamaoka, Shingo Nishihiro, Isao Date, Satoshi Murai, Kazuhiko Nishi, Tomohito Hishikawa, Yu Takahashi, Naoya Kidani, Masafumi Hiramatsu
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Hemodynamics
Single Center
030218 nuclear medicine & medical imaging
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Modified Rankin Scale
Angioplasty
medicine
Humans
Carotid Stenosis
Radiology
Nuclear Medicine and imaging
Aged
Retrospective Studies
Aged
80 and over
Tomography
Emission-Computed
Single-Photon
business.industry
Retrospective cohort study
Syndrome
medicine.disease
Magnetic Resonance Imaging
eye diseases
Cerebral Angiography
Surgery
Acetazolamide
Cerebrovascular Disorders
Stenosis
Cerebral blood flow
Regional Blood Flow
Female
Stents
Neurology (clinical)
Cardiology and Cardiovascular Medicine
Complication
business
Intracranial Hemorrhages
Angioplasty
Balloon
030217 neurology & neurosurgery
Zdroj: Neuroradiology. 62:503-510
ISSN: 1432-1920
0028-3940
DOI: 10.1007/s00234-019-02343-5
Popis: Intracranial hemorrhage following hyperperfusion syndrome (HPS) is a rare but potentially fatal complication after carotid artery stenting (CAS). Staged angioplasty (SAP) is a two-stage form of CAS that can prevent the abrupt increase of cerebral blood flow. In this study, we investigated the safety and efficacy of SAP. One hundred thirty-four patients who underwent CAS for high-grade carotid artery stenosis between January 2010 and December 2018 were enrolled. Patients who showed severe impairment of hemodynamic reserve in 123I-IMP SPECT with acetazolamide received SAP (SAP group), while the others received regular CAS (RS group). Twenty-six (19.4%) patients at risk for HPS received SAP. HPS was not observed in either group. Diffusion-weighted image (DWI)-positive lesions on postoperative MRI were observed in 56 (52.3%) cases in the RS group and 16 (64.0%) cases in the SAP group. Symptomatic procedure-related complications occurred in 5 (4.6%) cases in the RS group and 1 (3.8%) case in the SAP group. These differences were not statistically significant. Modified Rankin Scale score had declined 30 days after discharge in 4 (3.0%) cases. Distal filter protection was significantly correlated to the occurrence of new DWI-positive lesions. For patients at high risk of HPS, SAP was a reasonable treatment strategy to prevent HPS. SAP did not increase the rate of DWI-positive lesions or procedure-related complications compared with regular CAS.
Databáze: OpenAIRE
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