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Safety and efficacy of staged angioplasty for patients at risk of hyperperfusion syndrome: a single-center retrospective study

  • Interventional Neuroradiology
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Abstract

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.

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References

  1. Meyers PM, Higashida RT, Phatouros CC, Malek AM, Lempert TE, Dowd CF et al (2000) Cerebral hyperperfusion syndrome after percutaneous transluminal stenting of the craniocervical arteries. Neurosurgery 47:335–343

    Article  CAS  Google Scholar 

  2. Abou-Chebl A, Yadav JS, Reginelli JP, Bajzer C, Bhatt D, Krieger DW (2004) Intracranial hemorrhage and hyperperfusion syndrome following carotid artery stenting: risk factors, prevention, and treatment. J Am Coll Cardiol 43:1596–1601

    Article  Google Scholar 

  3. Ogasawara K, Sakai N, Kuroiwa T, Hosoda K, Iihara K, Toyoda K, Sakai C, Nagata I, Ogawa A, Japanese Society for Treatment at Neck in Cerebrovascular Disease Study Group (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. Solomon RA, Loftus CM, Quest DO, Correll JW (1986) Incidence and etiology of intracerebral hemorrhage following carotid endarterectomy. J Neurosurg 64:29–34

    Article  CAS  Google Scholar 

  5. Reigel MM, Hollier LH, Sundt TM Jr, Piepgras DG, Sharbrough FW, Cherry KJ (1987) Cerebral hyperperfusion syndrome: a cause of neurologic dysfunction after carotid endarterectomy. J Vasc Surg 5:628–634

    Article  CAS  Google Scholar 

  6. Yoshimura S, Kitajima H, Enomoto Y, Yamada K, Iwama T (2009) Staged angioplasty for carotid artery stenosis to prevent postoperative hyperperfusion. Neurosurgery 64:ons122–ons128

    Article  Google Scholar 

  7. Iida H, Nakagawara J, Hayashida K, Fukushima K, Watabe H, Koshino K, Zeniya T, Eberl S (2010) Multicenter evaluation of a standardized protocol for rest and acetazolamide cerebral blood flow assessment using a quantitative SPECT reconstruction program and split-dose 123I-iodoamphetamine. J Nucl Med 51:1624–1631

    Article  Google Scholar 

  8. Moulakakis KG, Mylonas SN, Sfyroeras GS, Andrikopoulos V (2009) Hyperperfusion syndrome after carotid revascularization. J Vasc Surg 49:1060–1068

    Article  Google Scholar 

  9. van Mook WN, Rennenberg RJ, Schurink GW, van Oostenbrugge RJ, Mess WH, Hofman PA, de Leeuw PW (2005) Cerebral hyperperfusion syndrome. Lancet Neurol 4:877–888

    Article  Google Scholar 

  10. Mo D, Luo G, Wang B, Ma N, Gao F, Sun X, Xu X, Miao Z (2016) Staged carotid artery angioplasty and stenting for patients with high-grade carotid stenosis with high risk of developing hyperperfusion injury: a retrospective analysis of 44 cases. Stroke Vasc Neurol 1:147–153

    Article  Google Scholar 

  11. Uchida K, Yoshimura S, Shirakawa M, Shindo S, Egashira Y, Iwama T et al (2015) Experience of staged angioplasty to avoid hyperperfusion syndrome for carotid artery stenosis. Neurol Med Chir (Tokyo) 55:824–829

    Article  Google Scholar 

  12. Hayakawa M, Sugiu K, Yoshimura S, Hishikawa T, Yamagami H, Fukuda-Doi M et al (2019) Effectiveness of staged angioplasty for avoidance of cerebral hyperperfusion syndrome after carotid revascularization. J Neurosurg 18:1–11

    Google Scholar 

  13. Yadav JS, Wholey MH, Kuntz RE, Fayad P, Katzen BT, Mishkel GJ, Bajwa TK, Whitlow P, Strickman NE, Jaff MR, Popma JJ, Snead DB, Cutlip DE, Firth BG, Ouriel K, Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators (2004) Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med 351:1493–1501

    Article  CAS  Google Scholar 

  14. Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23

    Article  CAS  Google Scholar 

  15. Rosenfield K, Matsumura JS, Chaturvedi S, Riles T, Ansel GM, Metzger DC et al (2016) Randomized trial of stent versus surgery for asymptomatic carotid stenosis. N Engl J Med 374:1011–1120

    Article  CAS  Google Scholar 

  16. Kastrup A, Nägele T, Gröschel K, Schmidt F, Vogler E, Schulz J, Ernemann U (2006) Incidence of new brain lesions after carotid stenting with and without cerebral protection. Stroke 37:2312–2316

    Article  Google Scholar 

  17. Bonati LH, Jongen LM, Haller S, Flach HZ, Dobson J, Nederkoorn PJ, Macdonald S, Gaines PA, Waaijer A, Stierli P, Jäger HR, Lyrer PA, Kappelle LJ, Wetzel SG, van der Lugt A, Mali WP, Brown MM, van der Worp H, Engelter ST, ICSS-MRI study group (2010) New ischaemic brain lesions on MRI after stenting or endarterectomy for symptomatic carotid stenosis: a substudy of the International Carotid Stenting Study (ICSS). Lancet Neurol 9:353–362

    Article  Google Scholar 

  18. Gensicke H, van der Worp HB, Nederkoorn PJ, Macdonald S, Gaines PA, van der Lugt A, Mali WP, Lyrer PA, Peters N, Featherstone RL, de Borst GJ, Engelter ST, Brown MM, Bonati LH, ICSS-MRI Substudy Investigators (2015) Ischemic brain lesions after carotid artery stenting increase future cerebrovascular risk. J Am Coll Cardiol 65:521–529

    Article  Google Scholar 

  19. Gröschel K, Ernemann U, Schulz JB, Nägele T, Terborg C, Kastrup A (2006) Statin therapy at carotid angioplasty and stent placement: effect on procedure-related stroke, myocardial infarction, and death. Radiology 240:145–151

    Article  Google Scholar 

  20. Tadros RO, Vouyouka AG, Chung C, Malik RK, Krishnan P, Ellozy SH, Marin ML, Faries PL (2013) The effect of statin use on embolic potential during carotid angioplasty and stenting. Ann Vasc Surg 27:96–103

    Article  Google Scholar 

  21. Reiff T, Amiri H, Rohde S, Hacke W, Ringleb PA (2014) Statins reduce peri-procedural complications in carotid stenting. Eur J Vasc Endovasc Surg 48:626–632

    Article  CAS  Google Scholar 

  22. Takayama K, Taki W, Toma N, Nakahara I, Maeda M, Tanemura H, Kuroiwa T, Imai K, Sakamoto M, Nakagawa I, Masuo O, Myouchin K, Wada T, Suzuki H (2014) Effect of pitavastatin on preventing ischemic complications with carotid artery stenting: a multicenter prospective study--EPOCH-CAS study. Cardiovasc Intervent Radiol 37:1436–1443

    Article  Google Scholar 

  23. Nagashima H, Hongo K, Nagm A (2018) Change in cerebral blood flow after palliative percutaneous angioplasty and timing of second stage carotid artery stenting in staged angioplasty. Neurol Med Chir (Tokyo) 58:254–259

    Article  Google Scholar 

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The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan

    Satoshi Murai, Kenji Sugiu, Tomohito Hishikawa, Masafumi Hiramatsu, Shingo Nishihiro, Naoya Kidani, Yu Takahashi, Kazuhiko Nishi, Yoko Yamaoka & Isao Date

Authors
  1. Satoshi Murai
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  2. Kenji Sugiu
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  3. Tomohito Hishikawa
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  4. Masafumi Hiramatsu
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  5. Shingo Nishihiro
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  6. Naoya Kidani
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  7. Yu Takahashi
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  8. Kazuhiko Nishi
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  9. Yoko Yamaoka
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  10. Isao Date
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Corresponding author

Correspondence to Kenji Sugiu.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Murai, S., Sugiu, K., Hishikawa, T. et al. Safety and efficacy of staged angioplasty for patients at risk of hyperperfusion syndrome: a single-center retrospective study. Neuroradiology 62, 503–510 (2020). https://doi.org/10.1007/s00234-019-02343-5

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  • DOI: https://doi.org/10.1007/s00234-019-02343-5

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