Prognostic Value of T2-FLAIR Hyperintense Vessel Sign for Cerebral Hyperperfusion Syndrome and Feasibility of
Dongdong Wan1, Chao Wang2, Hua Liu1
1Department of Neurosurgery, The Second People's Hospital of Shizuishan, Ningxia, China.
Insights
Preoperative T2-FLAIR hyperintense vessel sign (HVS) grading reliably predicts cerebral hyperperfusion syndrome (CHS) risk after carotid artery stenting (CAS). An HVS-guided management strategy is feasible and safe, showing promising clinical application.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Cerebral hyperperfusion syndrome (CHS) is a risk after carotid artery stenting (CAS).
- Predictive markers for CHS are crucial for patient management.
- T2-FLAIR hyperintense vessel sign (HVS) is a potential imaging marker.
Purpose of the Study:
- To evaluate the prognostic performance of preoperative T2-FLAIR HVS grading for CHS after CAS.
- To assess the clinical feasibility and safety of an HVS-guided risk-stratified perioperative management strategy.
Main Methods:
- A single-center prospective cohort study of 128 patients undergoing elective CAS.
- Patients were stratified into low-risk (HVS 0-1), intermediate-risk (HVS 2), and high-risk (HVS 3) groups.
- Tailored interventions included staged angioplasty and tiered blood pressure control.
Main Results:
- The 30-day symptomatic CHS incidence was 6.3%, with stepwise increases across HVS risk groups (0% to 24%, P<0.001).
- HVS grade ≥2 (OR=6.87) and incomplete circle of Willis (OR=3.72) correlated with higher CHS odds.
- No intergroup differences in procedural complications; CHS incidence was lower than historical controls.
Conclusions:
- Preoperative T2-FLAIR HVS grading is a reliable prognostic marker for CHS risk stratification in CAS patients.
- The HVS-guided risk-stratified perioperative management is clinically feasible and safe.
- HVS is a promising, accessible imaging indicator for routine clinical practice, warranting further multicenter validation.
Objective:
This study aimed to assess the prognostic performance of preoperative T2-FLAIR hyperintense vessel sign (HVS) grading for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS), and to evaluate the clinical feasibility and safety of an HVS-guided risk-stratified perioperative management strategy.
Methods:
A single-center prospective cohort study was conducted on 128 consecutive patients with symptomatic carotid stenosis ≥70 who underwent elective CAS. All participants were categorized into 3 groups based on preoperative HVS grades: low-risk (HVS 0-1), intermediate-risk (HVS 2), and high-risk (HVS 3). Tailored interventions, including session-based staged angioplasty and tiered systolic blood pressure control, were implemented across all groups. The primary clinical endpoint was 30-day symptomatic CHS. Firth penalized logistic regression was applied for exploratory analysis of factors associated with CHS occurrence.
Results:
The overall 30-day incidence of symptomatic CHS was 6.3%, with a stepwise rising risk across low-risk (0%), intermediate-risk (5.3%), and high-risk (24%) HVS subgroups (P < 0.001). Exploratory regression analysis revealed that HVS grade ≥2 (OR=6.87, 95% CI: 2.91-16.23, P < 0.001) and incomplete circle of Willis (OR=3.72, 95% CI: 1.58-8.76, P = 0.003) were correlated with higher CHS odds. There were no intergroup differences in total procedural complications, and the CHS incidence of our cohort was numerically lower than that of a historical control group.
Conclusions:
Preoperative T2-FLAIR HVS grading serves as a reliable prognostic marker for stratifying CHS risk in patients receiving CAS. The HVS-guided risk-stratified perioperative management protocol is clinically feasible and safe. As a widely accessible imaging indicator, HVS has promising application value in routine clinical practice. Further large-scale multicenter studies are warranted to validate our findings.
