Yoo Dong Hyun, Roh Hong Gee, Choi See-Sung, Moon Jusun, Lee Jeongjun, Cho Young Dae, Han Moon Hee, Jung Keun-Hwa, Yoon Byung-Woo, Kang Hyun-Seung
Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, South Korea.
Department of Radiology, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, South Korea.
J Clin Neurosci. 2018 Jul;53:74-78. doi: 10.1016/j.jocn.2018.04.007. Epub 2018 Apr 21.
Cerebral hyperperfusion syndrome (CHS) is serious complication after carotid artery stenting (CAS) caused by decreased cerebral vasoreactivity (CVR) due to long standing hypoperfusion of the brain. We hypothesized that partial dilatation of carotid stenosis would allow the recovery of CVR, and prevent CHS when definitive angioplasty with stent is performed afterward. In this study, we aimed to evaluate the safety and efficacy of staged CAS in patients with severe carotid artery stenosis with evident hemodynamic compromise in regard to preventing hyperperfusion syndrome. From January 2005 to February 2016, 53 patients with 55 severe carotid artery stenosis lesions showing decreased CVR and/or cerebral basal flow at the perfusion studies underwent staged CAS in three institutes. The procedure consisted of initial partial balloon angioplasty (BA), recovery period, and delayed definitive stenting (DS). We analyzed immediate results, complications, recoil and CHS related to staged CAS. We experienced no symptomatic manifestation of CHS except self-limited headache after the procedures. The median of intervals between BA and DS stages were 10 days. There was no case of severe recoil during the interval between BA and DS stage. Where perfusion imaging data was available, hyperperfusion was present in three and one patients after BA and DS stage, respectively, with no clinical symptom of CHS. In conclusion, staged CAS was feasible in patients with severe carotid artery stenosis and hemodynamic compromise, without inducing severe complication of CHS such as intracranial hemorrhage.
脑过度灌注综合征（CHS）是颈动脉支架置入术（CAS）后一种严重的并发症，由长期脑灌注不足导致脑血管反应性（CVR）降低引起。我们推测，颈动脉狭窄的部分扩张可使CVR恢复，并在随后进行确定性支架血管成形术时预防CHS。在本研究中，我们旨在评估分期CAS对严重颈动脉狭窄且血流动力学明显受损患者预防过度灌注综合征的安全性和有效性。2005年1月至2016年2月，53例患有55处严重颈动脉狭窄病变且在灌注研究中显示CVR降低和/或脑基底血流减少的患者在三个机构接受了分期CAS。该手术包括初始部分球囊血管成形术（BA）、恢复期和延迟确定性支架置入术（DS）。我们分析了与分期CAS相关的即时结果、并发症、回缩和CHS。除术后出现自限性头痛外，我们未观察到CHS的症状表现。BA和DS阶段之间的间隔中位数为10天。在BA和DS阶段之间的间隔期未出现严重回缩病例。在有灌注成像数据的情况下，分别有3例和1例患者在BA和DS阶段后出现过度灌注，但无CHS的临床症状。总之，分期CAS对严重颈动脉狭窄和血流动力学受损的患者是可行的，不会引发如颅内出血等严重的CHS并发症。
