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Prediction of cerebral hyperperfusion syndrome after carotid artery stenting by CT perfusion imaging with acetazolamide challenge

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

Cerebral hyperperfusion syndrome (HPS) is an uncommon but serious complication of carotid artery stenting (CAS). The purpose of this study was to investigate the efficacy of CT perfusion imaging (CTP) with acetazolamide challenge to identify patients at risk for HPS after CAS.

Methods

We retrospectively analyzed 113 patients who underwent CTP with rest and acetazolamide challenge before CAS. CTP maps were assessed for absolute and relative cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and change of each parameter before and after acetazolamide challenge. Patients were divided into two groups according to the HPS after the CAS. Receiver-operating characteristic (ROC) curve analysis was performed to determine the most accurate CTP parameter for the prediction of HPS.

Results

Nine of 113 patients had HPS. There were significant differences for absolute and relative values of resting CBF (p = 0.001 and p = 0.026), resting MTT (p < 0.001 and p = 0.004), post-acetazolamide CBF (p < 0.001 and p = 0.001), post-acetazolamide MTT (p < 0.001 and p = 0.002), and %changes of CBF (p = 0.009) between the HPS and non-HPS groups. ROC curve analysis showed that the CTP parameters with the maximal area under the receiver-operating characteristic curve (AUC) for HPS was the absolute value of post-acetazolamide MTT (AUC 0.909) and the absolute value of resting MTT (AUC 0.896).

Conclusion

Pretreatment CTP with acetazolamide challenge could identify patients at risk for HPS after CAS. Although the CTP parameter that most accurately identified patients at risk for HPS was the absolute value of post-acetazolamide MTT, resting MTT was sufficiently accurate.

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Authors and Affiliations

  1. Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, 3-435, Kosugimachi, Nakahara-ku, Kawasaki, 211-0063, Japan

    Tomohide Yoshie, Toshihiro Ueda, Tatsuro Takada, Shinji Nogoshi & Takayuki Fukano

  2. Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan

    Yasuhiro Hasegawa

Authors
  1. Tomohide Yoshie
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  2. Toshihiro Ueda
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  3. Tatsuro Takada
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  4. Shinji Nogoshi
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  5. Takayuki Fukano
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  6. Yasuhiro Hasegawa
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Corresponding author

Correspondence to Tomohide Yoshie.

Ethics declarations

We declare that all human and animal studies have been approved by our institutional Ethics Committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.

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We declare that we have no conflict of interest.

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Yoshie, T., Ueda, T., Takada, T. et al. Prediction of cerebral hyperperfusion syndrome after carotid artery stenting by CT perfusion imaging with acetazolamide challenge. Neuroradiology 58, 253–259 (2016). https://doi.org/10.1007/s00234-015-1623-4

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  • DOI: https://doi.org/10.1007/s00234-015-1623-4

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