Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Japan.
J Stroke Cerebrovasc Dis. 2013 Jul;22(5):615-9. doi: 10.1016/j.jstrokecerebrovasdis.2011.10.015. Epub 2011 Dec 28.
Hyperperfusion syndrome (HPS) is a rare but severe complication after carotid artery stenting (CAS). Reliable methods for predicting HPS remain to be developed. We aimed to establish a predictive value of hemorrhagic HPS after CAS. Our retrospective study included 136 consecutive patients who had undergone CAS. We determined the cerebral circulation time (CCT) by measuring the interval between the point of maximal opacification of the terminal portion of the internal carotid artery and the cortical vein. We calculated intraprocedural CCT changes (ΔCCT) by subtracting postprocedural CCT values from preprocedural CCT values. The mean ΔCCT was 0.9 ± 0.9 seconds; 3 patients (2.2%) with prolonged ΔCCT (2.7, 5.4, and 5.8 seconds) developed HPS. The cutoff time of 2.7 seconds predicted hemorrhagic HPS retrospectively with 100% sensitivity and 99% specificity. Our findings suggest that post-CAS HPS can be predicted by using the ΔCCT value obtained by intraprocedural digital subtraction angiography. Patients with a ΔCCT >2.7 seconds require careful intensive hemodynamic and neurologic monitoring after CAS.
高灌注综合征（HPS）是颈动脉支架置入术（CAS）后一种罕见但严重的并发症。目前仍需要开发可靠的方法来预测 HPS。我们旨在建立 CAS 后出血性 HPS 的预测价值。我们的回顾性研究纳入了 136 例连续接受 CAS 的患者。我们通过测量颈内动脉终末部分最浓显点与皮质静脉之间的间隔来确定脑循环时间（CCT）。我们通过从术前 CCT 值中减去术后 CCT 值来计算术中 CCT 变化（ΔCCT）。平均 ΔCCT 为 0.9±0.9 秒；3 名（2.2%）患者的 ΔCCT 延长（2.7、5.4 和 5.8 秒）发生了 HPS。2.7 秒的截止时间可预测出血性 HPS，其敏感性为 100%，特异性为 99%。我们的研究结果表明，可通过术中数字减影血管造影获得的 ΔCCT 值来预测 CAS 后 HPS。ΔCCT＞2.7 秒的患者在 CAS 后需要仔细进行强化血流动力学和神经监测。
