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Diana F, Frauenfelder G, Botto A, Saponiero R, Romano DG. Cerebral hyperperfusion syndrome after intracranial stenting: Case report and systematic review. Interv Neuroradiol 2021; 27:843-849. [PMID: 33884930 PMCID: PMC8673892 DOI: 10.1177/15910199211011860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/18/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cerebral Hyperperfusion Syndrome (CHS) is an uncommon complication observed after intracranial angioplasty or stenting procedures. Given to the increasing use of new devices for intracranial angioplasty and stenting (INCS), in selected patients with high ischemic stroke risk, an equally increasing knowledge of complications related to these procedures is mandatory.Case description: a 63-year-old man was diagnosed with an hyperperfusion syndrome after percutaneous angioplasty and stenting for severe symptomatic right internal carotid artery (ICA) siphon stenosis. After treatment he complained generalized seizures and respiratory failure. While conventional imaging did not demonstrate any acute brain lesions, Pseudo-Continuous Arterial Spin Labeling (PCASL) Perfusion MRI early documented right hemisphere blood flow increase suggestive for CHS. CONCLUSIONS Monitoring of perfusion changes after INCS could play an important a role in determining patients with high risk of CHS. ASL Perfusion MRI might be used for promptly, early diagnosis of CHS after treatment of severe intracranial artery stenosis.
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Affiliation(s)
- Francesco Diana
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Salerno, Italy
| | - Giulia Frauenfelder
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Salerno, Italy
| | - Annibale Botto
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Salerno, Italy
| | - Renato Saponiero
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Salerno, Italy
| | - Daniele Giuseppe Romano
- Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Salerno, Italy
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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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Mansour A, Rashad S, Niizuma K, Fujimura M, Tominaga T. A novel model of cerebral hyperperfusion with blood-brain barrier breakdown, white matter injury, and cognitive dysfunction. J Neurosurg 2019; 133:1460-1472. [PMID: 31628277 DOI: 10.3171/2019.7.jns19212] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cerebral hyperperfusion (CHP) is associated with considerable morbidity. Its pathophysiology involves disruption of the blood-brain barrier (BBB) with subsequent events such as vasogenic brain edema and ischemic and/or hemorrhagic complications. Researchers are trying to mimic the condition of CHP; however, a proper animal model is still lacking. In this paper the authors report a novel surgically induced CHP model that mimics the reported pathophysiology of clinical CHP including BBB breakdown, white matter (WM) injury, inflammation, and cognitive impairment. METHODS Male Sprague-Dawley rats were subjected to unilateral common carotid artery (CCA) occlusion and contralateral CCA stenosis. Three days after the initial surgery, the stenosis of CCA was released to induce CHP. Cortical regional cerebral blood flow was measured using laser speckle flowmetry. BBB breakdown was assessed by Evans blue dye extravasation and matrix metalloproteinase-9 levels. WM injury was investigated with Luxol fast blue staining. Cognitive function was assessed using the Barnes circular maze. Other changes pertaining to inflammation were also assessed. Sham-operated animals were prepared and used as controls. RESULTS Cerebral blood flow was significantly raised in the cerebral cortex after CHP induction. CHP induced BBB breakdown evident by Evans blue dye extravasation, and matrix metalloproteinase-9 was identified as a possible culprit. WM degeneration was evident in the corpus callosum and corpus striatum. Immunohistochemistry revealed macrophage activation and glial cell upregulation as an inflammatory response to CHP in the striatum and cerebral cortex. CHP also caused significant impairments in spatial learning and memory compared with the sham-operated animals. CONCLUSIONS The authors report a novel CHP model in rats that represents the pathophysiology of CHP observed in various clinical scenarios. This model was produced without the use of pharmacological agents; therefore, it is ideal to study the pathology of CHP as well as to perform preclinical drug trials.
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Affiliation(s)
- Ahmed Mansour
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- 2Department of Neurosurgery, Menoufia University Graduate School of Medicine, Menoufia, Egypt
| | - Sherif Rashad
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- 3Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai
| | - Kuniyasu Niizuma
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- 3Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai
- 4Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai; and
| | - Miki Fujimura
- 5Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Teiji Tominaga
- 1Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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4
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Fu C, Xu Z, Hu Z, Yao S, Liu F, Feng B, Zhao C, Yu W. Cortical blindness as a rare presentation of hemorrhagic cerebral hyperperfusion syndrome following vertebral angioplasty. J Neurointerv Surg 2018; 10:e21. [PMID: 29563211 DOI: 10.1136/neurintsurg-2017-013412.rep] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 11/04/2022]
Abstract
Cerebral hyperperfusion syndrome (CHS) is a well-documented complication after carotid endarterectomy or stenting. In contrast, CHS following vertebral revascularization is extremely rare. Here we present a case of a 77-year-old man with high-grade vertebral stenosis who subsequently underwent balloon angioplasty, complicated by hemorrhagic CHS manifesting as cortical blindness, although strict postoperative blood pressure control was administered. To our knowledge, cortical blindness as a presentation of hemorrhagic CHS has not previously been reported. This study highlights the fact that identifying high-risk patients, as well as making an individual therapeutic plan, is important prior to revascularization. Further studies are needed to elucidate the exact mechanism of this condition and thereby prevent it.
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Affiliation(s)
- Chao Fu
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhongxin Xu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhenzhen Hu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shuai Yao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Fengmin Liu
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Baiqi Feng
- Department of Neurosurgery, Qianguo County Hospital, Songyuan, China
| | - Conghai Zhao
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Weidong Yu
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
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5
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Fu C, Xu Z, Hu Z, Yao S, Liu F, Feng B, Zhao C, Yu W. Cortical blindness as a rare presentation of hemorrhagic cerebral hyperperfusion syndrome following vertebral angioplasty. BMJ Case Rep 2017; 2017:bcr-2017-013412. [PMID: 29084739 DOI: 10.1136/bcr-2017-013412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Cerebral hyperperfusion syndrome (CHS) is a well-documented complication after carotid endarterectomy or stenting. In contrast, CHS following vertebral revascularization is extremely rare. Here we present a case of a 77-year-old man with high-grade vertebral stenosis who subsequently underwent balloon angioplasty, complicated by hemorrhagic CHS manifesting as cortical blindness, although strict postoperative blood pressure control was administered. To our knowledge, cortical blindness as a presentation of hemorrhagic CHS has not previously been reported. This study highlights the fact that identifying high-risk patients, as well as making an individual therapeutic plan, is important prior to revascularization. Further studies are needed to elucidate the exact mechanism of this condition and thereby prevent it.
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Affiliation(s)
- Chao Fu
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhongxin Xu
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhenzhen Hu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shuai Yao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Fengmin Liu
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Baiqi Feng
- Department of Neurosurgery, Qianguo County Hospital, Songyuan, China
| | - Conghai Zhao
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Weidong Yu
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, China
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6
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Fukuda K, Abe H, Ueba T, Okawa M, Higashi T, Inoue T. Posterior Circulation Hyperperfusion Syndrome after Superficial Temporal Artery–Superior Cerebellar Artery Bypass for Vertebral Artery Dissection. J Stroke Cerebrovasc Dis 2014; 23:583-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/07/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022] Open
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Ito K, Yonaha H, Kai Y, Hokama Y, Nagamine H, Miyagi T, Watanabe T, Ishiuchi S. Hyperperfusion syndrome after stent placement for subclavian artery stenosis: case report. Neurol Med Chir (Tokyo) 2012; 52:902-5. [PMID: 23269046 DOI: 10.2176/nmc.52.902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 60-year-old woman presented with a rare case of hyperperfusion syndrome after stent placement for subclavian artery stenosis manifesting as dizziness due to vertebrobasilar insufficiency. Three days after undergoing stent placement to treat the severely stenotic (90%) right subclavian artery, she suffered intracranial hemorrhage related to hyperperfusion syndrome. Preoperative single-photon emission computed tomography findings of low cerebral perfusion and poor perfusion reserve might indicate the possibility of hyperperfusion syndrome after stenting in patients with subclavian artery stenosis.
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Affiliation(s)
- Koichi Ito
- Department of Neurosurgery, Chubutokushukai Hospital, Okinawa, Okinawa
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8
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Mordasini P, Brekenfeld C, Fung C, Do DD, Schroth G, Gralla J. Excessive contrast medium leakage in hyperperfusion syndrome. Clin Neuroradiol 2011; 21:223-9. [PMID: 21293836 DOI: 10.1007/s00062-010-0052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 12/23/2010] [Indexed: 11/29/2022]
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9
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Tavares A, Caldas JG, Castro CC, Puglia P, Frudit ME, Barbosa LA. Changes in perfusion-weighted magnetic resonance imaging after carotid angioplasty with stent. Interv Neuroradiol 2010; 16:161-9. [PMID: 20642890 DOI: 10.1177/159101991001600207] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 03/28/2010] [Indexed: 11/16/2022] Open
Abstract
Carotid artery stenosis due to arteriosclerosis increases the risk of cerebral ischemia via embolic phenomena or reduced blood flow. The changes in cerebral perfusion that may occur after treatment are not clearly understood. This study evaluated the changes in cerebral microcirculation following carotid angioplasty with stenting (CAS) under cerebral protection with filters using ultrafast gradient echo (GRE) perfusion weighted imaging (PWI) with magnetic resonance imaging (MRI). Prospectively, 21 cervical carotid stenosis patients, mean age 69.95 years, underwent MRI 12 h before and 72 h after CAS. PWI parameters were collected for statistical analysis: cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP). Statistical analysis was applied to absolute parameters and to values normalized against those from the contralateral parenchyma. The main finding of this study was improved hemodynamics for the normalized data after CAS, shown by reduced MTT (p<0.001) and TTP (p=0.019) in the territory fed by the middle cerebral artery ipsilateral to the CAS. Absolute data showed increased blood volume in the cerebral hemispheres after CAS, which was more accentuated on the stent side (p=0.016) than the contralateral side (p=0.029). Early improvements in cerebral perfusion, mainly seen in the normalized data, were clearly demonstrated in the timing parameters - TTP & MTT - after CAS.
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Affiliation(s)
- A Tavares
- Universidade de São Paulo, São Paulo, Brazil.
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10
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Schumacher HC, Meyers PM, Higashida RT, Derdeyn CP, Lavine SD, Nesbit GM, Sacks D, Rasmussen P, Wechsler LR. Reporting standards for angioplasty and stent-assisted angioplasty for intracranial atherosclerosis. J Vasc Interv Radiol 2009; 20:S451-73. [PMID: 19560032 DOI: 10.1016/j.jvir.2009.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Revised: 10/27/2008] [Accepted: 11/04/2008] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracranial cerebral atherosclerosis causes ischemic stroke in a significant number of patients. Technological advances over the past 10 years have enabled endovascular treatment of intracranial atherosclerotic stenosis. The number of patients treated with angioplasty or stent-assisted angioplasty for this condition is increasing. Given the lack of universally accepted definitions, the goal of this document is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting clinical and radiological evaluation, technique, and outcome of endovascular treatment using angioplasty or stent-assisted angioplasty for stenotic and occlusive intracranial atherosclerosis. SUMMARY OF REPORT This article was written under the auspices of Joint Writing Group of the Technology Assessment Committee, Society of NeuroInterventional Surgery, Society of Interventional Radiology; Joint Section on Cerebrovascular Neurosurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and the Section of Stroke and Interventional Neurology of the American Academy of Neurology. A computerized search of the National Library of Medicine database of literature (PubMed) from January 1997 to December 2007 was conducted with the goal to identify published endovascular cerebrovascular interventional data in stenotic intracranial atherosclerosis that could be used as benchmarks for quality assessment. We sought to identify those risk adjustment variables that affect the likelihood of success and complications. This document offers the rationale for different clinical and technical considerations that may be important during the design of clinical trials for endovascular treatment of intracranial stenotic and occlusive atherosclerosis. Included in this guidance document are suggestions for uniform reporting standards for such trials. These definitions and standards are primarily intended for research purposes; however, they should also be helpful in clinical practice and applicable to all publications. CONCLUSION In summary, the definitions proposed represent recommendations for constructing useful research data sets. The intent is to facilitate production of scientifically rigorous results capable of reliable comparisons between and among similar studies. In some cases, the definitions contained here are recommended by consensus of a panel of experts in this writing group for consistency in reporting and publication. These definitions should allow different groups to publish results that are directly comparable.
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Affiliation(s)
- H Christian Schumacher
- Saul R. Korey Department of Neurology, Division of Vascular Neurology and Neurocritical Care, Albert Einstein College of Medicine, Bronx, NY, USA
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11
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Posterior Circulation Hyperperfusion Syndrome after Bilateral Vertebral Artery Intracranial Stenting. Ann Vasc Surg 2009; 23:686.e1-5. [DOI: 10.1016/j.avsg.2008.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 08/23/2008] [Accepted: 09/16/2008] [Indexed: 11/18/2022]
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12
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Schumacher HC, Meyers PM, Higashida RT, Derdeyn CP, Lavine SD, Nesbit GM, Sacks D, Rasmussen P, Wechsler LR. Reporting Standards for Angioplasty and Stent-Assisted Angioplasty for Intracranial Atherosclerosis. Stroke 2009; 40:e348-65. [PMID: 19246710 DOI: 10.1161/strokeaha.108.527580] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Intracranial cerebral atherosclerosis causes ischemic stroke in a significant number of patients. Technological advances over the past 10 years have enabled endovascular treatment of intracranial atherosclerotic stenosis. The number of patients treated with angioplasty or stent-assisted angioplasty for this condition is increasing. Given the lack of universally accepted definitions, the goal of this document is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting clinical and radiological evaluation, technique, and outcome of endovascular treatment using angioplasty or stent-assisted angioplasty for stenotic and occlusive intracranial atherosclerosis.
Summary of Report—
This article was written under the auspices of Joint Writing Group of the Technology Assessment Committee, Society of NeuroInterventional Surgery, Society of Interventional Radiology; Joint Section on Cerebrovascular Neurosurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and the Section of Stroke and Interventional Neurology of the American Academy of Neurology. A computerized search of the National Library of Medicine database of literature (PubMed) from January 1997 to December 2007 was conducted with the goal to identify published endovascular cerebrovascular interventional data in stenotic intracranial atherosclerosis that could be used as benchmarks for quality assessment. We sought to identify those risk adjustment variables that affect the likelihood of success and complications. This document offers the rationale for different clinical and technical considerations that may be important during the design of clinical trials for endovascular treatment of intracranial stenotic and occlusive atherosclerosis. Included in this guidance document are suggestions for uniform reporting standards for such trials. These definitions and standards are primarily intended for research purposes; however, they should also be helpful in clinical practice and applicable to all publications.
Conclusion—
In summary, the definitions proposed represent recommendations for constructing useful research data sets. The intent is to facilitate production of scientifically rigorous results capable of reliable comparisons between and among similar studies. In some cases, the definitions contained here are recommended by consensus of a panel of experts in this writing group for consistency in reporting and publication. These definitions should allow different groups to publish results that are directly comparable.
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Affiliation(s)
- H Christian Schumacher
- Saul R Korey Department of Neurology, Division of Vascular Neurology and Neurocritical Care, Albert Einstein College of Medicine, Bronx, NY, USA
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Terada T, Tsuura M, Matsumoto H, Masuo O, Tsumoto T, Yamaga H, Ohura Y, Itakura T. Hemorrhagic Complications after Endovascular Therapy for Atherosclerotic Intracranial Arterial Stenoses. Neurosurgery 2006; 59:310-8; discussion 310-8. [PMID: 16823323 DOI: 10.1227/01.neu.0000225326.81661.68] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE:
Hemorrhagic complications were analyzed in 106 procedures of 99 patients treated with percutaneous transluminal angioplasty (PTA) or stenting for intracranial arterial stenoses.
METHODS:
Ninety-nine patients with intracranial arterial stenosis were treated with PTA or stenting 106 times from January 1995 to December 2003. Fifty-seven patients had intracranial internal carotid artery stenosis, 23 had middle cerebral artery stenosis, and 19 had vertebrobasilar stenosis. Evaluation of hemodynamic compromise via single-photon emission computed tomography was performed 50 times for 50 patients before the treatment.
RESULTS:
Four hemorrhagic complications occurred in 106 procedures. Two of these cases involved intracerebral hemorrhage after PTA or stenting in the treated vascular territory 30 minutes and 16 hours after the treatment, respectively. One case showed subarachnoid hemorrhage, which appeared 6 hours after treatment. Hemodynamic compromise was found on single-photon emission computed tomography in these three cases. The last case with a hemorrhagic complication was a hemorrhagic infarction after recanalization of stent thrombosis, which appeared 3 days after stenting. Hyperperfusion syndrome was strongly suggested as the cause of hemorrhage in the two cases associated with intracerebral hemorrhage.
CONCLUSION:
The rate of hemorrhagic complication directly related to the procedure of PTA or stenting was 3%, and hyperperfusion syndrome was suggested as the cause of hemorrhage in two cases (2%), from the perspective of clinical characteristics and single-photon emission computed tomographic findings.
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Affiliation(s)
- Tomoaki Terada
- Department of Neurological Surgery, Wakayama Medical University, Wakayama City, Japan.
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14
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van Mook WNKA, Rennenberg RJMW, Schurink GW, van Oostenbrugge RJ, Mess WH, Hofman PAM, de Leeuw PW. Cerebral hyperperfusion syndrome. Lancet Neurol 2005; 4:877-88. [PMID: 16297845 DOI: 10.1016/s1474-4422(05)70251-9] [Citation(s) in RCA: 350] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy is characterised by ipsilateral headache, hypertension, seizures, and focal neurological deficits. If not treated properly it can result in severe brain oedema, intracerebral or subarachnoid haemorrhage, and death. Knowledge of CHS among physicians is limited. Most studies report incidences of CHS of 0-3% after carotid endarterectomy. CHS is most common in patients with increases of more than 100% in perfusion compared with baseline after carotid endarterectomy and is rare in patients with increases in perfusion less than 100% compared with baseline. The most important risk factors in CHS are diminished cerebrovascular reserve, postoperative hypertension, and hyperperfusion lasting more than several hours after carotid endarterectomy. Impaired autoregulation as a result of endothelial dysfunction mediated by generation of free oxygen radicals is implicated in the pathogenesis of CHS. Treatment strategies are directed towards regulation of blood pressure and limitation of rises in cerebral perfusion. Complete recovery happens in mild cases, but disability and death can occur in more severe cases. More information about CHS and early institution of adequate treatment are of paramount importance in order to prevent these potentially severe complications.
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Affiliation(s)
- Walther N K A van Mook
- Department of Internal Medicine and Intensive Care, University Hospital Maastricht, Maastricht, Netherlands.
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15
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Cagnie B, Vinck E, Cambier D. The role of SPECT imaging in the diagnosis of vertebrobasilar insufficiency. Nucl Med Commun 2005; 26:299-301. [PMID: 15753788 DOI: 10.1097/00006231-200504000-00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schumacher HC, Khaw AV, Meyers PM, Gupta R, Higashida RT. Intracranial Angioplasty and Stent Placement for Cerebral Atherosclerosis. J Vasc Interv Radiol 2004; 15:S123-32. [PMID: 15101521 DOI: 10.1097/01.rvi.0000107488.61085.8f] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Intracranial atherosclerotic stenoses have been estimated to account for 8%-10% of all ischemic strokes. A substantial number of patients fail the best medical treatment, which includes control of vascular risk factors and administration of antithrombotics (platelet-active drugs or warfarin), statins, and angiotensin-converting enzyme inhibitors. In these patients, angioplasty with stent placement is one reasonable treatment option for preventing massive ischemic stroke. Herein, we discuss basic pathophysiologic concepts and their effect on endovascular revascularization procedures.
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Affiliation(s)
- H Christian Schumacher
- Doris and Stanley Tananbaum Stroke Center, Neurological Institute, New York-Presbyterian Hospital, College of Physicians & Surgeons, Columbia University, 710 West 168th Street, New York, NY 10032, USA
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