Key result
Staged carotid artery angioplasty and stenting resulted in a 2.2% rate of immediate hyperperfusion syndrome and significant improvements in cerebral blood flow.
Why the study?
Does staged carotid artery angioplasty and stenting prevent hyperperfusion syndrome in patients with high-grade carotid stenosis at high risk of hyperperfusion injury?
Observational (n=44)
Does staged carotid artery angioplasty and stenting prevent hyperperfusion syndrome in patients with high-grade carotid stenosis at high risk of hyperperfusion injury?
Staged carotid artery stenting appears to be a safe and effective alternative to prevent hyperperfusion syndrome in high-risk patients with high-grade carotid stenosis.
Answers are grounded in this paper and cite their sources.
May reduce hyperperfusion risk in select high-grade stenosis; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Hyperperfusion syndrome (HPS) is a rare but potentially a life-threatening complication after carotid artery angioplasty and stenting (CAS). Staged CAS has been an alternative to prevent HPS. MATERIALS AND METHODS: 44 of 908 patients with high-grade internal carotid artery stenosis or near occlusion were at risk of HPS because of poor collateral flow and impaired cerebral blood flow (CBF). They were treated with first (stage 1), followed by a full CAS (stage 2) 1 month later. Their 30-day outcomes were tabulated and analysed. RESULTS: During follow-up, 1 of the 44 (2.2%) patients developed HPS immediately, 3 (7%) had postprocedural HPS (ie, transcranial Doppler (TCD) >120%) without clinical symptoms and 3 (7%) required stenting at stage 1 for carotid dissections. After stage 1, there were significant improvement between the preprocedural and postprocedural CBF (0.98±0.06 vs 0.85±0.05, p<0.05), mean transit time (MTT; 1.05±0.05 vs 1.15±0.05, p<0.05), time to peak (TTP; 1.04±0.06 vs 1.20±0.06, p<0.05) on CT perfusion (CTP), and CBF (66.41±7.41 vs 44.44±6.43, p<0.05) on TCD. After stage 2, improvement was seen in CBF (1.01±0.07 vs 0.98±0.06, p<0.05), MTT (1.01±0.05 vs 1.05±0.05, p<0.05), TTP (0.99±0.06 vs 1.04±0.06, p<0.05) on CTP and CBF (66.41±7.41 vs 93.78±18.81, p<0.05) on TCD. 2 had postoperative increase of middle cerebral artery mean flow velocity of 120% after stage 2 without clinical symptoms. CONCLUSION: Staged carotid artery stenting probably decreased the chance of developing HPS in this group of selected patients. Although requiring a 2-step intervention, staged CAS may be a safe and effective alternative.
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Mo et al. (2016) conducted an observational in High-grade internal carotid artery stenosis or near occlusion (n=44). Staged carotid artery angioplasty and stenting (CAS) was evaluated on Immediate hyperperfusion syndrome (HPS). Staged carotid artery angioplasty and stenting resulted in a 2.2% rate of immediate hyperperfusion syndrome and significant improvements in cerebral blood flow.
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