• Neurosurgery · Sep 2017

    Prediction of Cerebral Hyperperfusion After Carotid Artery Stenting by Cerebral Angiography and Single-Photon Emission Computed Tomography Without Acetazolamide Challenge.

    • Tsuyoshi Ohta, Ichiro Nakahara, Shoji Matsumoto, Ryota Ishibashi, Haruka Miyata, Hidehisa Nishi, Sadayoshi Watanabe, and Izumi Nagata.
    • Department of Neurosurgery, Kochi Health Sciences Center, Kochi City, Kochi Prefecture, Japan.
    • Neurosurgery. 2017 Sep 1; 81 (3): 512-519.

    BackgroundDefinitive preoperative predictors of cerebral hyperperfusion following carotid artery stenting are yet to be established.ObjectiveTo determine the preprocedural risk factors for cerebral hyperperfusion phenomenon (CHP) following carotid artery stenting.MethodsPatients undergoing preprocedural single-photon emission computed tomography (SPECT) and cerebral angiography prior to their first carotid artery stenting were monitored for occurrence of CHP. In addition to patient characteristics, we investigated imaging parameters, such as cerebral blood flow, cerebral vasoreactivity, and asymmetry index on SPECT, and presence of near occlusion and leptomeningeal anastomosis on cerebral angiography.ResultsOut of 100 patients (mean age: 73.0 ± 7.6 years; 85 men), 9 developed CHP. On multivariate logistic regression analysis, asymmetry index (%) on SPECT (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.70-0.93, P = .003) and presence of leptomeningeal anastomosis on cerebral angiography (OR 72.1, 95% CI 3.52-1480, P = .006) were independent predictors of CHP.ConclusionCombined use of cerebral angiography and SPECT may obviate the need for acetazolamide challenge to predict the risk of CHP following carotid artery stenting.Copyright © 2017 by the Congress of Neurological Surgeons

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