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The role of perfusion computed tomography in the prediction of cerebral hyperperfusion syndrome
Chien Hung Chang1, Ting Yu Chang, Yeu Jhy Chang
1Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Kueishan, Taoyuan, Taiwan.
Insights
Predicting hyperperfusion syndrome (HPS) after carotid stenting is crucial. Perfusion CT parameters, including regional cerebral blood volume (rCBV) and time to peak (TTP), combined with stenosis severity and blood pressure, can help identify high-risk patients.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Hyperperfusion syndrome (HPS) following carotid angioplasty with stenting (CAS) presents significant risks.
- Current methods for predicting HPS are unreliable.
- Perfusion computed tomography (CT) is being investigated as a predictive tool.
Purpose of the Study:
- To evaluate the feasibility and reliability of perfusion CT in predicting HPS after CAS.
- To identify predictors of HPS in patients undergoing CAS.
Main Methods:
- Retrospective case-control study of 54 patients (11 HPS, 43 non-HPS) who underwent CAS.
- Comparison of vascular risk factors and perfusion CT parameters (rCBV, rCBF, TTP).
- Multivariable logistic regression analysis to identify independent predictors.
Main Results:
- Independent predictors of HPS included severe ipsilateral carotid artery stenosis, 3-hour mean systolic blood pressure (SBP) post-CAS, pre-stenting rCBV index >0.15, and TTP index >0.22.
- Eleven patients developed HPS, with five experiencing intracranial hemorrhages (ICHs).
Conclusions:
- A combination of severe carotid stenosis, post-CAS SBP, rCBV index, and TTP index can serve as a screening tool for HPS prediction.
- Effective post-stenting blood pressure management is critical for HPS prevention.
Background:
Hyperperfusion syndrome (HPS) following carotid angioplasty with stenting (CAS) is associated with significant morbidity and mortality. At present, there are no reliable parameters to predict HPS. The aim of this study was to clarify whether perfusion computed tomography (CT) is a feasible and reliable tool in predicting HPS after CAS.
Methodology/Principal Findings:
We performed a retrospective case-control study of 54 patients (11 HPS patients and 43 non-HPS) with unilateral severe stenosis of the carotid artery who underwent CAS. We compared the prevalence of vascular risk factors and perfusion CT parameters including regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and time to peak (TTP) within seven days prior to CAS. Demographic information, risk factors for atherosclerosis, and perfusion CT parameters were evaluated by multivariable logistic regression analysis. The rCBV index was calculated as [(ipsilateral rCBV - contralateral rCBV)/contralateral rCBV], and indices of rCBF and TTP were similarly calculated. We found that eleven patients had HPS, including five with intracranial hemorrhages (ICHs) of whom three died. After a comparison with non-HPS control subjects, independent predictors of HPS included the severity of ipsilateral carotid artery stenosis, 3-hour mean systolic blood pressure (3 h SBP) after CAS, pre-stenting rCBV index >0.15 and TTP index >0.22.
Conclusions/Significance:
The combination of severe ipsilateral carotid stenosis, 3 h SBP after CAS, rCBV index and TTP index provides a potential screening tool for predicting HPS in patients with unilateral carotid stenosis receiving CAS. In addition, adequate management of post-stenting blood pressure is the most important treatable factor in preventing HPS in these high risk patients.
