Lin C-J, Chang F-C, Tsai F-Y, Guo W-Y, Hung S-C, Chen D Y-T, Lin C-H, Chang C-Y
From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), National Yang Ming University, Taipei, Taiwan.
Imaging Research Center (F.-Y.T., D.Y.-T.C.), Taipei Medical University, Taipei, Taiwan
AJNR Am J Neuroradiol. 2014 Jun;35(6):1132-6. doi: 10.3174/ajnr.A3838. Epub 2014 Jan 16.
Hyperperfusion syndrome is a devastating complication of carotid stent placement. The shortening of cerebral circulation time after stent placement is seen as a good indicator of the development of hyperperfusion syndrome. The purpose of our study was to evaluate whether patients with ipsilateral transverse sinus stenosis are prone to having shortened cerebral circulation time after stent placement, subsequently leading to the possible development of hyperperfusion syndrome.
Forty-nine patients with >70% unilateral carotid stenosis undergoing stent placement were recruited for analysis. Group A consisted of patients with a stenotic ipsilateral transverse sinus >50% greater than the diameter of the contralateral transverse sinus; the remaining patients were in group B. Quantitative DSA was used to calculate cerebral circulation time. Cerebral circulation time was defined as the time difference between the relative time to maximal intensity of ROIs in the proximal internal carotid artery and the internal jugular vein. ΔCCT was defined as cerebral circulation time before stent placement minus cerebral circulation time after stent placement. ΔCCT, white matter hyperintensity signals, and sulcal effacement in MR imaging were compared between the 2 groups.
ΔCCT was significantly shorter in group A (0.65 ± 1.3) than in group B (-0.12 ± 1.4). Three patients had white matter hyperintensity signals in group A, and 1 developed hyperperfusion syndrome. Group B showed no MR imaging signs of hyperperfusion syndrome.
Ipsilateral hypoplastic transverse sinus was associated with prolonged cerebral circulation time before stent placement and greatly shortened cerebral circulation time after stent placement. Inadequate venous drainage might play a role in impaired cerebral autoregulation and might influence the development of poststenting hyperperfusion syndrome.
高灌注综合征是颈动脉支架置入术的一种严重并发症。支架置入术后脑循环时间缩短被视为高灌注综合征发生的一个良好指标。我们研究的目的是评估同侧横窦狭窄的患者在支架置入术后是否易于出现脑循环时间缩短，进而导致高灌注综合征的可能发生。
招募49例单侧颈动脉狭窄>70%并接受支架置入术的患者进行分析。A组由同侧横窦狭窄程度比对侧横窦直径大>50%的患者组成；其余患者为B组。采用定量数字减影血管造影（DSA）计算脑循环时间。脑循环时间定义为颈内动脉近端和颈内静脉感兴趣区（ROI）达到最大强化的相对时间之差。ΔCCT定义为支架置入术前脑循环时间减去支架置入术后脑循环时间。比较两组之间的ΔCCT、磁共振成像（MR成像）中的白质高信号和脑沟变平情况。
A组的ΔCCT（0.65±1.3）明显短于B组（-0.12±1.4）。A组有3例患者出现白质高信号，1例发生高灌注综合征。B组未显示高灌注综合征的MR成像征象。
同侧横窦发育不全与支架置入术前脑循环时间延长及支架置入术后脑循环时间大幅缩短有关。静脉引流不畅可能在脑自动调节受损中起作用，并可能影响支架置入术后高灌注综合征的发生。
