PURPOSE 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. METHODS 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). RESULTS 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. CONCLUSIONS 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.

中文翻译：

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分期血管成形术对有高灌注综合征风险的患者的安全性和有效性：一项单中心回顾性研究。

目的高灌注综合征（HPS）后颅内出血是一种罕见的但在颈动脉支架置入术（CAS）后可能致命的并发症。分期血管成形术（SAP）是CAS的两阶段形式，可以防止脑血流量的突然增加。在这项研究中，我们调查了SAP的安全性和有效性。方法纳入2010年1月至2018年12月期间因CAS进行的严重颈动脉狭窄的134例患者。乙酰唑胺在123I-IMP SPECT中显示严重血流动力学储备受损的患者接受SAP（SAP组），其他患者接受常规CAS（RS组）。结果有26名（19.4％）有HPS风险的患者接受了SAP。两组均未观察到HPS。术后MRI上的弥散加权图像（DWI）阳性病变在56例中被观察到（52。RS组为3％），SAP组为16（64.0％）。有症状的与手术相关的并发症在RS组发生5例（4.6％），在SAP组发生1例（3.8％）。这些差异无统计学意义。改良的Rankin量表评分在出院后30天下降了4（3.0％）例。远端滤器保护与新的DWI阳性病变的发生显着相关。结论对于HPS高危患者，SAP是预防HPS的合理治疗策略。与常规CAS相比，SAP并未增加DWI阳性病变或与手术相关的并发症的发生率。这些差异无统计学意义。改良的Rankin量表评分在出院后30天下降了4（3.0％）例。远端滤器保护与新的DWI阳性病变的发生显着相关。结论对于HPS高危患者，SAP是预防HPS的合理治疗策略。与常规CAS相比，SAP并未增加DWI阳性病变或与手术相关的并发症的发生率。这些差异无统计学意义。改良的Rankin量表评分在出院后30天下降了4（3.0％）例。远端滤器保护与新的DWI阳性病变的发生显着相关。结论对于HPS高危患者，SAP是预防HPS的合理治疗策略。与常规CAS相比，SAP并未增加DWI阳性病变或与手术相关的并发症的发生率。