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Relationship between cerebral hyperperfusion syndrome and the immediate change of cerebral blood flow after carotid artery stenting evaluated by single-photon emission computed tomography

  • Diagnostic Neuroradiology
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Abstract

Purpose

Cerebral hyperperfusion syndrome (CHS) is a critical complication after carotid artery stenting (CAS). However, few CAS studies have evaluated immediate and temporary changes in ipsilateral cerebral blood flow (CBF) quantitatively. The study was performed to evaluate immediate changes in CBF after CAS and subsequent CBF changes in patients with cerebral hyperperfusion (HP) using 123I-IMP SPECT.

Methods

The subjects were 223 patients with chronic extracranial carotid artery stenosis who underwent CAS in our department between March 2010 and March 2020. Quantitative CBF and cerebrovascular reactivity to acetazolamide in the middle cerebral artery were assessed before CAS by 123I-IMP SPECT. CBF was also measured immediately after CAS by 123I-IMP SPECT. When HP was detected, CBF was measured again 3 and 7 days after CAS.

Results

The median (interquartile range) ipsilateral quantitative CBF change after CAS was − 0.1% (− 9.5–8.2%), and the upper value of the 95% CI of the quantitative CBF change was 48.2%. Thus, we defined HP after CAS as an increase in quantitative CBF of > 48.2% compared with the preoperative value. Of 223 patients, 5 (2.2%) had HP, and 4 of these patients (80%) developed CHS. In the CHS patients, HP was maintained for about 3 days and improved after about 7 days.

Conclusion

An immediate CBF increase of > 48.2% after CAS may lead to development of CHS. In CHS after CAS, HP persisted for about 1 week and postoperative management may be required for at least 1 week.

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Availability of data and material

Data will be made available on request.

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References

  1. Huibers AE, Westerink J, de Vries EE et al (2018) Cerebral hyperperfusion syndrome after carotid artery stenting: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg 56:322–333

    Article  Google Scholar 

  2. Piepgras DG, Morgan MK, Sundt TM Jr et al (1988) Intracerebral hemorrhage after carotid endarterectomy. J Neurosurg 68:532–536

    Article  CAS  Google Scholar 

  3. Ogasawara K, Sakai N, Kuroiwa T et al (2007) Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients. J Neurosurg 107:1130–1136

    Article  Google Scholar 

  4. van Mook WN, Rennenberg RJ, Schurink GW et al (2005) Cerebral hyperperfusion syndrome. Lancet Neurol 4:877–888

    Article  Google Scholar 

  5. Ogasawara K, Yukawa H, Kobayashi M et al (2003) Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning. J Neurosurg 99:504–510

    Article  Google Scholar 

  6. Kuhl DE, Barrio JR, Huang SC et al (1982) Quantifying local cerebral blood flow by N-isopropyl-p-[123I]iodoamphetamine (IMP) tomography. Nucl Med 23:196–203

    CAS  Google Scholar 

  7. Matsubara S, Moroi J, Suzuki A et al (2009) Analysis of cerebral perfusion and metabolism assessed with positron emission tomography before and after carotid artery stenting. J Neurosurg 11:28–36

    Article  Google Scholar 

  8. Nishizawa S, Tanada S, Yonekura Y et al (1989) Regional dynamics of N-isopropyl-(123I)p-iodoamphetamine in human brain. Nucl Med 30:150–156

    CAS  Google Scholar 

  9. North American Symptomatic Carotid Endarterectomy Trial (1991) Methods, patient characteristics, and progress. Stroke 22:711–720

    Article  Google Scholar 

  10. Abou-Chebl A, Reginelli J, Bajzer CT et al (2007) Intensive treatment of hypertension decreases the risk of hyperperfusion and intracerebral hemorrhage following carotid artery stenting. Catheter Cardiovasc Interv 69:690–696

    Article  Google Scholar 

  11. Oka F, Ishihara H, Kato S et al (2013) Cerebral hemodynamic benefits after contralateral carotid artery stenting in patients with internal carotid artery occlusion. AJNR Am J Neuroradiol 34:616–621

    Article  CAS  Google Scholar 

  12. Yamada S, Kobayashi M, Watanabe Y et al (2014) Quantitative measurement of blood flow volume in the major intracranial arteries by using 123i-iodoamphetamine SPECT. Clin Nucl Med 39:868–873

    Article  Google Scholar 

  13. Kim KM, Watabe H, Hayashi T et al (2006) Quantitative mapping of basal and vasareactive cerebral blood flow using split-dose 123I-iodoamphetamine and single photon emission computed tomography. Neuroimage 33:1126–1135

    Article  Google Scholar 

  14. Minoshima S, Frey KA, Koeppe RA et al (1995) A diagnostic approach in Alzheimer’s disease using three-dimensional stereotactic surface projections of fluorine-18-FDG PET. J Nucl Med 36:1238–1248

    CAS  PubMed  Google Scholar 

  15. Mizumura S, Nakagawara J, Takahashi M et al (2004) Three-dimensional display in staging hemodynamic brain ischemia for JET study: objective evaluation using SEE analysis and 3D-SSP display. Ann Nucl Med 18:13–21

    Article  Google Scholar 

  16. Ogura T, Hida K, Masuzuka T et al (2009) An automated ROI setting method using Neurostat on cerebral blood flow SPECT images. Ann Nucl Med 23:33–41

    Article  Google Scholar 

  17. Minoshima S, Koeppe RA, Frey KA et al (1994) Anatomic standardization: linear scaling and nonlinear warping of functional brain images. J Nucl Med 35:1528–1537

    CAS  PubMed  Google Scholar 

  18. Iwata T, Mori T, Tajiri H et al (2011) Predictors of hyperperfusion syndrome before and immediately after carotid artery stenting in single-photon emission computed tomography and transcranial color-coded real-time sonography studies. Neurosurgery 68:649–655

    Article  Google Scholar 

  19. Wang S, Han J, Cheng L et al (2017) Risk factors and preventive measures of cerebral hyperperfusion syndrome after carotid artery interventional therapy. Exp Ther Med 14:2517–2520

    Article  Google Scholar 

  20. Bouri S, Thapar A, Shalhoub J et al (2011) Hypertension and the post-carotid endarterectomy cerebral hyperperfusion syndrome. Eur J Vasc Endovasc Surg 41:229–237

    Article  CAS  Google Scholar 

  21. Komoribayashi N, Ogasawara K, Kobayashi M et al (2006) Cerebral hyperperfusion after carotid endarterectomy is associated with preoperative hemodynamic impairment and intraoperative cerebral ischemia. J Cereb Blood Flow Metab 26:878–884

    Article  Google Scholar 

  22. Suga Y, Ogasawara K, Saito H et al (2007) Preoperative cerebral hemodynamic impairment and reactive oxygen species produced during carotid endarterectomy correlate with development of postoperative cerebral hyperperfusion. Stroke 38:2712–2717

    Article  Google Scholar 

  23. Horie N, Kitagawa N, Morikawa M et al (2005) Monitoring of regional cerebral oxygenation by near-infrared spectroscopy in carotid arterial stenting: preliminary study. Neuroradiology 47:375–379

    Article  Google Scholar 

  24. Schluter M, Tubler T, Mathey DG et al (2002) Feasibility and efficacy of balloon-based neuroprotection during carotid artery stenting in a single-center setting. J Am Coll Cardiol 40:890–895

    Article  Google Scholar 

  25. Kuroda H, Ogasawara K, Hirooka R et al (2009) Prediction of cerebral hyperperfusion after carotid endarterectomy using middle cerebral artery signal intensity in preoperative single-slab 3-dimensional time-of-flight magnetic resonance angiography. Neurosurgery 64:1065–1071

    Article  Google Scholar 

  26. Timmers HJLM, Wieling W, Karemaker JM et al (2004) Baroreflex failure: a neglected type of secondary hypertension. Neth J Med 62:151–155

    CAS  PubMed  Google Scholar 

  27. Barry MC, Hendriks JM, Alberts G et al (2004) Comparison of catecholamine hormone release in patients undergoing carotid artery stenting or carotid endarterectomy. Endovasc Ther 11:240–250

    Article  Google Scholar 

  28. Dangas G, Laird JR, Satler LF et al (2000) Postprocedural hypotension after carotid artery stent placement: predictors and short- and long-term clinical outcomes. Radiology 215:677–683

    Article  CAS  Google Scholar 

  29. Lim S, Javorski MJ, Nassoiy SP et al (2019) Long-term hemodynamic effects after carotid artery revascularization. Vasc Endovascular Surg 53:297–302

    Article  Google Scholar 

  30. McKevitt FM, Sivaguru A, Venables GS et al (2003) Effect of treatment of carotid artery stenosis on blood pressure: a comparison of hemodynamic disturbances after carotid endarterectomy and endovascular treatment. Stroke 34:2576–2581

    Article  CAS  Google Scholar 

  31. Bladin CF, Chambers BR (1994) Frequency and pathogenesis of hemodynamic stroke. Stroke 25(2):2179–2182

    Article  CAS  Google Scholar 

  32. Orlandi G, Fanucchi S, Fioretti C et al (2001) Characteristics of cerebral microembolism during carotid stenting and angioplasty alone. Arch Neurol 58:1410–1413

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Yamaguchi University School of Medicine, 1-1-1, Minamikogushi, Ube, Yamaguchi, 755-8505, Japan

    Takuma Nishimoto, Fumiaki Oka, Koki Okazaki & Hideyuki Ishihara

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  1. Takuma Nishimoto
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  2. Fumiaki Oka
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  3. Koki Okazaki
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  4. Hideyuki Ishihara
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Contributions

T.N. studied the concept and design and helped in the analysis and interpretation and preparation of the article. F.O. helped in the interpretation of data and critical revision of the article for important intellectual content. K.O. carried out data analysis and interpretation and helped in the preparation of the article. H.I. helped to draft the manuscript. All authors read and approved the final manuscript.

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Correspondence to Takuma Nishimoto.

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The authors have no financial or non-financial interests to disclose.

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This study was conducted retrospectively from data obtained for clinical purposes. The study was approved by the IRB of Yamaguchi University School of Medicine.

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Nishimoto, T., Oka, F., Okazaki, K. et al. Relationship between cerebral hyperperfusion syndrome and the immediate change of cerebral blood flow after carotid artery stenting evaluated by single-photon emission computed tomography. Neuroradiology 64, 1157–1164 (2022). https://doi.org/10.1007/s00234-021-02822-8

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  • DOI: https://doi.org/10.1007/s00234-021-02822-8

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