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Fan X, Lai Z, Lin T, Li K, Hou B, You H, Wei J, Qu J, Liu B, Zuo Z, Feng F. Multidelay MR Arterial Spin Labeling Perfusion Map for the Prediction of Cerebral Hyperperfusion After Carotid Endarterectomy. J Magn Reson Imaging 2023; 58:1245-1255. [PMID: 36951494 DOI: 10.1002/jmri.28634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Multidelay arterial spin labeling (ASL) generates time-resolved perfusion maps, which may provide sufficient and accurate hemodynamic information in carotid stenosis. PURPOSE To use imaging markers derived from multidelay ASL magnetic resonance imaging (MRI) and to determine the optimal strategy for predicting cerebral hyperperfusion after carotid endarterectomy (CEA). STUDY TYPE Prospective observational cohort. SUBJECTS A total of 79 patients who underwent CEA for carotid stenosis. FIELD STRENGTH/SEQUENCE A 3.0 T/pseudo-continuous ASL with three postlabeling delays of 1.0, 1.57, and 2.46 seconds using fast-spin echo readout. ASSESSMENT Cerebral perfusion pressure, antegrade, and collateral flow were scored on a four-grade ordinal scale based on preoperative multidelay ASL perfusion maps. Simultaneously, quantitative hemodynamic parameters including cerebral blood flow (CBF), arterial transit time (ATT), relative CBF (rCBF) and relative ATT (rATT; ipsilateral/contralateral values) were calculated. On the CBF ratio map obtained through dividing postoperative by preoperative CBF map, regions of interest were placed covering ipsilateral middle cerebral artery territory. Three neuroradiologists conducted this procedure. Cerebral hyperperfusion was defined as a CBF ratio >2. STATISTICAL TESTS Weighted κ values, independent sample t test, chi-square test, Mann-Whitney U-test, multivariable logistic regression analysis, receiver-operating characteristic curve analysis, and Delong test. Significance level was P < 0.05. RESULTS Cerebral hyperperfusion was observed in 15 (19%) patients. Higher blood pressure (odd ratio [OR] = 1.08) and carotid near-occlusion (NO; OR = 7.31) were clinical risk factors for postoperative hyperperfusion. Poor ASL perfusion score (OR = 37.33), decreased CBF (OR = 0.74), prolonged ATT (OR = 1.02), lower rCBF (OR = 0.91), and higher rATT (OR = 1.12) were independent imaging predictors of hyperperfusion. ASL perfusion score exhibited the highest specificity (95.3%), while CBF exhibited the highest sensitivity (93.3%) for the prediction of hyperperfusion. When combined with ASL perfusion score, CBF and ATT, the predictive ability was significantly higher than using blood pressure and NO alone (AUC: 0.98 vs. 0.78). DATA CONCLUSIONS Multidelay ASL can accurately predict cerebral hyperperfusion after CEA with high sensitivity and specificity. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Xiaoyuan Fan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianye Lin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juan Wei
- GE Healthcare, MR Research China, Beijing, China
| | - Jianxun Qu
- GE Healthcare, MR Research China, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Hefei Comprehensive National Science Center, Institute of Artificial Intelligence, Hefei, China
- Sino-Danish college, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Difficult, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Fan X, Zuo Z, Lin T, Lai Z, You H, Qu J, Wei J, Liu B, Feng F. Arterial transit artifacts on arterial spin labeling MRI can predict cerebral hyperperfusion after carotid endarterectomy: an initial study. Eur Radiol 2022; 32:6145-6157. [PMID: 35394182 DOI: 10.1007/s00330-022-08755-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/28/2022] [Accepted: 03/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate whether preoperative arterial spin labeling (ASL) MRI can predict cerebral hyperperfusion after carotid endarterectomy (CEA) in patients with carotid stenosis. METHODS Consecutive patients with carotid stenosis who underwent CEA between May 2015 and July 2021 were included. For each patient, a cerebral blood flow ratio (rCBF) map was obtained by dividing postoperative CBF with preoperative CBF images from two pseudo-continuous ASL scans. Hyperperfusion regions with rCBF > 2 were extracted and weighted with rCBF to calculate the hyperperfusion index. According to the distribution of the hyperperfusion index, patients were divided into hyperperfusion and non-hyperperfusion groups. Preoperative ASL images were scored based on the presence of arterial transit artifacts (ATAs) in 10 regions of interest corresponding to the Alberta Stroke Programme Early Computed Tomography Score methodology. The degree of stenosis and primary and secondary collaterals were evaluated to correlate with the ASL score. Logistic regression and receiver operating characteristic curve analyses were performed to assess the predictive ability of the ASL score for cerebral hyperperfusion. RESULTS Of 86 patients included, cerebral hyperperfusion was present in 17 (19.8%) patients. Carotid near occlusion, opening of posterior communicating arteries with incomplete anterior semicircle, and leptomeningeal collaterals were associated with lower ASL scores (p < 0.05). The preoperative ASL score was an independent predictor of cerebral hyperperfusion (OR = 0.48 [95% CI [0.33-0.71]], p < 0.001) with the optimal cutoff value of 25 points (AUC = 0.98, 94.1% sensitivity, 88.4% specificity). CONCLUSIONS Based on the presence of ATAs, ASL can non-invasively predict cerebral hyperperfusion after CEA in patients with carotid stenosis. KEY POINTS • Carotid near occlusion, opening of posterior communicating arteries with incomplete anterior semicircle, and leptomeningeal collaterals were associated with lower ASL scores. • The ASL score performed better than the degree of stenosis, type of CoW, and leptomeningeal collaterals, as well as the combination of the three factors for the prediction of cerebral hyperperfusion. • For patients with carotid stenosis, preoperative ASL can non-invasively identify patients at high risk of cerebral hyperperfusion after carotid endarterectomy without complex post-processing steps.
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Affiliation(s)
- Xiaoyuan Fan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,Sino-Danish College, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Beijing, China
| | - Tianye Lin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Zhichao Lai
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China.
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Jianxun Qu
- GE Healthcare, MR Research China, Beijing, China
| | - Juan Wei
- GE Healthcare, MR Research China, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing, 100730, China. .,State Key Laboratory of Difficult, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Efficacy of pretreatment with the free radical scavenger, edaravone, for prevention of cerebral hyperperfusion after carotid artery stenting: A single-center randomized controlled trial. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Katsumata M, Tsuruta W, Hosoo H, Ishigami D. Suspected Cerebral Hyperperfusion Syndrome after Stenting for Intracranial Vertebral Artery Stenosis Associated with Reduced Cerebral Blood Flow to the Posterior Cerebral Artery Territory. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 15:460-466. [PMID: 37502784 PMCID: PMC10370887 DOI: 10.5797/jnet.cr.2020-0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/22/2020] [Indexed: 07/29/2023]
Abstract
Objective Although several studies have reported on cerebral hyperperfusion syndrome (CHS)/hyperperfusion phenomenon (HPP) involving the anterior circulation after carotid artery stenting (CAS), little is known about CHS/HPP involving the posterior circulation after percutaneous transluminal angioplasty (PTA) and stenting of the vertebral artery (VA). Case Presentation A 79-year-old man with known chronic occlusion of the left VA (V4 segment) was admitted to another hospital with right-sided hemiplegia, mild disturbance of consciousness, and dysphagia. A head MRI revealed multiple infarcts in posterior circulation areas, and severe stenosis of the right VA (V4 segment). Single photon emission computed tomography (SPECT) indicated reduced cerebral blood flow (CBF) in the posterior circulation, and DSA revealed 76% stenosis of the right V4 segment. On day 18, PTA/stenting was performed under general anesthesia for the severe stenosis of the right VA. However, head MRI and CT on postoperative day (POD)1 showed intracranial hemorrhage (ICH) occupying an area measuring 2 cm in diameter in the left posterior lobe and a small subdural hematoma (SDH). SPECT on POD1 indicated increased CBF in the posterior lobe, and we diagnosed CHS might have caused ICH. Although SPECT on POD4 showed residual hyperperfusion, SPECT on POD11 revealed reduced CBF in the posterior circulation area. Conclusion Our patient developed ICH after undergoing PTA/stenting for known severe symptomatic stenosis of the right VA. CHS/HPP in the posterior cerebral artery territory might be one of the etiologies, and reduced CBF prior to the procedure could be a risk factor for CHS/HPP developing after PTA/stenting.
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Affiliation(s)
- Masahiro Katsumata
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Hisayuki Hosoo
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
| | - Daiichiro Ishigami
- Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
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You C, Zhang X, Wu Y, Sun W, Li J, Zhang L, Hong B, Huang Q, Huang L, Li Q, Liu J, Fang Q. Solitaire stents deployment may reduce ischemic events in staged angioplasty for severe carotid stenosis. Vascular 2020; 29:535-542. [PMID: 33226306 DOI: 10.1177/1708538120965300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Cerebral hyperperfusion syndrome is a fatal complication that can occur after stent angioplasty in patients with severe carotid artery stenosis. Staged angioplasty can prevent cerebral hyperperfusion syndrome. Conventional staged angioplasty consists of small balloon angioplasty in the first stage and carotid artery stenting in the second stage two to four weeks later. Sometimes, antegrade flow during stage 1 could hardly be maintained and stent will be needed. Solitaire stents were used in some patients in our center. This study aimed to examine the safety and effectiveness of Solitaire stents in staged angioplasty. METHODS A retrospective analysis was performed on patients with severe carotid artery stenosis and preoperative computed tomography perfusion indicating risk of cerebral hyperperfusion syndrome from 2011 to 2018. Small balloon angioplasty (<3 mm in diameter) only was performed in stage 1 (group 1). If antegrade flow during stage 1 is compromised, then a solitaire stent is deployed (group 2). After two to four weeks, cerebral angiography was undertaken in both groups to determine whether to perform stage 2. If the residual stenosis was more than 50%, carotid artery stenting was deployed. Angiographic results, clinical results, and follow-up results were collected and analyzed. RESULTS Twenty-five patients were included in the study (group 1, n = 19; group 2, n = 6). After stage 1, no patient in group 2 and two patients in group 1 developed new symptomatic cerebral infarction (0.0% vs. 10.5%, p = 1.000). One patient in group 2 and three patients in group 1 (16.7% vs. 15.8%, p = 1.000) developed symptomatic cerebral hyperperfusion syndrome. One patient in group 2 (n = 4) and three patients in group 1 (n = 12) (25% vs. 25%, p = 1.000) developed hyperperfusion phenomenon. Two patients in group 2 and five patients in group 1 (33.3% vs. 26.3%, p = 1.000) developed symptomatic cerebral hyperperfusion syndrome or hyperperfusion phenomenon. One patient in group 1 developed symptomatic cerebral hyperperfusion syndrome and hyperperfusion phenomenon. After stage 2, no new cerebral infarction occurred in both groups. No patient in group 2 (n = 3) and one patient in group 1 (n = 17) developed symptomatic cerebral hyperperfusion syndrome (0.0% vs. 5.9%, p = 1.000). In the combined analysis of both stages, two patients (10.5%) developed new symptomatic cerebral infarction and four patients (21.1%) developed symptomatic cerebral hyperperfusion syndrome in group 1, no patient (0.0%) developed symptomatic cerebral infarction and one patient (16.7%) developed symptomatic cerebral hyperperfusion syndrome in group 2. There was no significant difference in symptomatic cerebral infarction and symptomatic cerebral hyperperfusion syndrome between the two groups (p = 1.000; p = 1.000). Three patients in group 2 and 17 patients in group 1 (50% vs. 89.5%, p = 0.070) underwent stage 2 angioplasty. No cerebral hemorrhage or cerebral infarction occurred in the Solitaire group during the one-year follow-up period. CONCLUSIONS Solitaire stents deployment may reduce ischemic events in staged angioplasty for severe carotid stenosis.
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Affiliation(s)
- Chunmei You
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China.,Department of Neurology, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Xiaomang Zhang
- Wujiaochang Community Health Service Center, Shanghai, China
| | - Yina Wu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wenjing Sun
- Department of Neurology, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Jianan Li
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lei Zhang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Bo Hong
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Liuqing Huang
- Department of Neurology, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Endo H, Fujimura M, Saito A, Endo T, Ootomo K, Tominaga T. Efficacy of arterial spin labeling magnetic resonance imaging with multiple post-labeling delays to predict postoperative cerebral hyperperfusion in carotid endarterectomy. Neurol Res 2020; 43:252-258. [PMID: 33190623 DOI: 10.1080/01616412.2020.1847529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: Cerebral hyperperfusion (CHP) syndrome is one of the most deleterious complications after carotid endarterectomy (CEA). Arterial spin labeling (ASL) is a promising non-invasive method to evaluate various hemodynamic parameters in cerebrovascular diseases. The aim of this study was to clarify whether ASL with multiple post-labeling delays (PLDs) can predict postoperative CHP after CEA. Methods: Sixty-one patients with carotid artery stenosis treated by CEA were retrospectively analyzed. The asymmetry index of the preoperative CBF was obtained from ASL using 3 PLDs (1525 ms, 2025 ms, and 2525 ms) and single-photon emission computed tomography (SPECT). Cerebrovascular reactivity (CVR) was measured from SPECT with acetazolamide challenge. The slope of the regression line obtained from the asymmetry index of three PLDs was defined as the slope index. Results: The CHP phenomenon was observed in seven patients (11.5%), one of whom developed CHP syndrome (1.6%). Using the CHP phenomenon as a reference standard, the area under the receiver operating characteristics (ROC) was 0.68 for the asymmetry index of the preoperative SPECT, 0.71 for the asymmetry index of the preoperative ASL,0.73 for CVR, and 0.78 for the slope index. Using the cutoff value obtained by ROC analysis, the slope index demonstrated a sensitivity of 85%, specificity of 74%, positive predictive value of 30% and the negative predictive value of 98% for predicting CHP. Conclusions: The slope index calculated by ASL with multiple PLDs is a useful screening tool to predict postoperative CHP after CEA.
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Affiliation(s)
- Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital , Sendai, Japan.,Department of Neurosurgery, Tohoku University Graduate School of Medicine , Sendai, Japan.,Department of Neurosurgery, National Hospital Organization Sendai Medical Center , Sendai, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Kohnan Hospital , Sendai, Japan.,Division of Advanced Cerebrovascular Surgery, Tohoku University Graduate School of Medicine , Sendai, Japan
| | - Atsushi Saito
- Department of Neurosurgery, Kohnan Hospital , Sendai, Japan.,Division of Advanced Cerebrovascular Surgery, Tohoku University Graduate School of Medicine , Sendai, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Kohnan Hospital , Sendai, Japan.,Department of Neurosurgery, Tohoku University Graduate School of Medicine , Sendai, Japan
| | | | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine , Sendai, Japan
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Efficacy of Acupuncture Combined with Local Anesthesia in Ischemic Stroke Patients with Carotid Artery Stenting: A Prospective Randomized Trial. Chin J Integr Med 2019; 26:609-616. [PMID: 31705448 DOI: 10.1007/s11655-019-3174-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy of electro-acupuncture (EA) or transcutaneous electrical acupoint stimulation (TEAS) on perioperative cerebral blood flow (CBF) and neurological function in ischemic stroke (IS) patients undergoing carotid artery stenting (CAS). METHODS In total, 124 consecutive IS patients were randomly allocated to the EA, TEAS, and sham groups (groups A, T, and S; 41, 42, and 41 cases, respectively) by software-derived random-number sequence. Groups A and T received EA and TEAS, respectively, at the Shuigou (GV 26) and Baihui (GV 20), Hegu (LI4) and Waiguan (TE 5) acupoints. Group S received sham EA. The stimulation was started from 30 min before surgery until the end of the operation. The primary outcome was the CBF at 30 min after surgery, which was measured by transcranial Doppler sonography. The secondary outcomes included hyperperfusion incidence and neurological function. National Institutes of Health Stroke Scale (NIHSS) and General Evaluation Scale (GES) scores were recorded at 1 week, 1 month, and 3 months postoperatively. RESULTS Mean CBF velocity at 30 min after surgery in groups A and T was much lower than that in Group S (P < 0.05); the incidence of hyperperfusion in Groups A and T was also lower than that in group S (P <0.05). Acupuncture was an independent factor associated with reduced incidence of hyperperfusion (OR=0.042; 95% CI: 0.002-0.785; =0.034). NIHSS and GES scores improved significantly at 1 week postoperatively in Groups A and T than in Group S (P < 0.05). Relative to Group S, groups A and T exhibited significantly lower incidences of moderate pain, as well as higher incidences of satisfaction with anesthesia, at 1 day postoperatively (P < 0.05). CONCLUSIONS EA or TEAS administered in combination with local anesthesia during CAS can inhibit transient increases in CBF, reduce the incidence of postoperative hyperperfusion, and improve neurological function. (Registration No. ChiCTR-IOR-15007447).
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Nakagawa I, Yokoyama S, Wajima D, Nishimura F, Yamada S, Yokota H, Motoyama Y, Park YS, Wada T, Kichikawa K, Nakase H. Hyperventilation and breath-holding test with indocyanine green kinetics predicts cerebral hyperperfusion after carotid artery stenting. J Cereb Blood Flow Metab 2019; 39:901-912. [PMID: 29148891 PMCID: PMC6501514 DOI: 10.1177/0271678x17743878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cerebral hyperperfusion syndrome (CHS) is a serious complication following carotid artery stenting (CAS), but definitive early prediction of CHS has not been established. Here, we evaluated whether indocyanine green kinetics and near-infrared spectroscopy (ICG-NIRS) with hyperventilation (HV) and the breath-holding (BH) test can predict hyperperfusion phenomenon after CAS. The blood flow index (BFI) ratio during HV and BH was prospectively monitored using ICG-NIRS in 66 patients scheduled to undergo CAS. Preoperative cerebrovascular reactivity (CVR) and the postoperative asymmetry index (AI) were also assessed with single-photon emission computed tomography before and after CAS and the correlation with the BFI HV/rest ratio, BFI BH/rest ratio was evaluated. Twelve cases (18%) showed hyperperfusion phenomenon, and one (1.5%) showed CHS after CAS. A significant linear correlation was observed between the BFI HV/rest ratio, BFI BH/rest ratio, and preoperative CVR. A significant linear correlation was observed between the BFI HV/rest ratio and postoperative AI (r = 0.674, P < 0.0001). A BFI HV/rest ratio of 0.88 or more was the optimal cut-off point to predict hyperperfusion phenomenon according to receiver operating characteristic curve analyses. HV and BH test under ICG-NIRS is a useful tool for detection of hyperperfusion phenomenon in patients who underwent CAS.
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Affiliation(s)
- Ichiro Nakagawa
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shohei Yokoyama
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Daisuke Wajima
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | | | - Shuichi Yamada
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroshi Yokota
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Yasushi Motoyama
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Young Su Park
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Takeshi Wada
- 2 Department of Radiology, Nara Medical University, Nara, Japan
| | | | - Hiroyuki Nakase
- 1 Department of Neurosurgery, Nara Medical University, Nara, Japan
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Iwata T, Mori T, Tanno Y, Kasakura S, Yoshioka K. Measurement of oxygen extraction fraction by blood sampling to estimate severe cerebral hemodynamic failure and anticipate cerebral hyperperfusion syndrome following carotid artery stenting. J Neurointerv Surg 2018; 10:1063-1066. [PMID: 29511115 DOI: 10.1136/neurintsurg-2018-013748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cerebral hyperperfusion syndrome (CHS) is likely to occur after carotid revascularization in patients with stage 2 hemodynamic failure (st2HF), in whom the oxygen extraction fraction (OEF) increases. OBJECTIVE The purpose of our study was to investigate whether measurement of the global cerebral OEF (gcOEF) by blood sampling can be used to estimate st2HF and anticipate CHS following carotid artery stenting (CAS). METHODS The OEF was calculated by blood sampling just before and after elective CAS. Data were collected prospectively. Patients who underwent elective CAS and gcOEF calculation were included in the study. Patients' baseline features, pre-CAS gcOEF, post-CAS gcOEF, and incidence of CHS (defined as headache, seizure, focal neurologic deficits, and/or restlessness) were evaluated. RESULTS 141 patients met the inclusion criteria and 134 patients were analyzed. Median pre-CAS gcOEF and post-CAS gcOEF were 0.41 and 0.42, respectively. Nine patients developed CHS. Median pre-CAS gcOEF was higher in patients with than in those without CHS (Mann-Whitney U test, P<0.05), but median post-CAS gcOEF was not significantly higher in patients with CHS (P=0.058). Scattergrams of patients with and without CHS showed that the cut-off values of the pre-CAS gcOEF and post-CAS gcOEF for anticipation of CHS were 0.46 (P<0.01) and 0.49 (P<0.001), respectively. CONCLUSION Elevation of the pre-CAS or post-CAS gcOEF by blood sampling allowed for anticipation of CHS following CAS. Elevation of the pre-CAS gcOEF might be associated with st2HF.
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Affiliation(s)
- Tomonori Iwata
- Department of Vascular Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan.,Department of Internal Medicine, Nayutanomori Hospital, Saga, Japan
| | - Takahisa Mori
- Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Kamakura, Japan
| | - Yuhei Tanno
- Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Kamakura, Japan
| | - Shigen Kasakura
- Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Kamakura, Japan
| | - Kazuhiro Yoshioka
- Department of Stroke Treatment, Shonan Kamakura General Hospital Stroke Center, Kamakura, Japan
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Cerebral Hyperperfusion Syndrome After Endovascular Reperfusion Therapy in a Patient with Acute Internal Carotid Artery and Middle Cerebral Artery Occlusions. World Neurosurg 2017; 110:145-151. [PMID: 29146434 DOI: 10.1016/j.wneu.2017.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/02/2017] [Accepted: 11/04/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cerebral hyperperfusion syndrome (CHS) is known to be a rare but devastating complication of carotid artery revascularization. Because patients with acute ischemic stroke due to acute major cerebral and/or cervical artery occlusion treated with endovascular reperfusion therapy may have impaired autoregulation in the cerebral vasculature, these patients may also develop CHS. Despite the growing number of endovascular reperfusion procedures for acute ischemic stroke, this complication has only rarely been reported. CASE DESCRIPTION A 77-year-old man developed acute cerebral infarction as the result of occlusions of the right internal carotid artery and right middle cerebral artery. After systemic intravenous injection of recombinant tissue-type plasminogen activator, endovascular reperfusion therapy was initiated. The occluded arteries were successfully recanalized with thrombectomy by using a stent retriever for the middle cerebral artery and stent placement for the origin of the internal carotid artery. However, head computed tomography obtained 12 hours after treatment showed acute intracranial hemorrhage that did not involve the ischemic lesions. Under evaluation with transcranial near-infrared spectroscopy and single-photon emission computed tomography, the hemorrhage was considered to have been caused by CHS after reperfusion therapy. CONCLUSIONS CHS may lead to unfavorable outcomes after reperfusion therapy for acute ischemic stroke. Recognizing clinical deterioration caused by CHS can be challenging in patients with neurologic disorders of acute ischemic stroke. Therefore, it is important to perform routine monitoring of regional cerebral oxygen saturation by using near-infrared spectroscopy, perform single-photon emission computed tomography promptly to evaluate cerebral blood flow, and maintain strict antihypertensive therapy to prevent CHS after reperfusion therapy.
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