TY - JOUR
T1 - Prediction of cerebral hyperperfusion after carotid artery stenting by cerebral angiography and single-photon emission computed tomography without acetazolamide challenge
AU - Ohta, Tsuyoshi
AU - Nakahara, Ichiro
AU - Matsumoto, Shoji
AU - Ishibashi, Ryota
AU - Miyata, Haruka
AU - Nishi, Hidehisa
AU - Watanabe, Sadayoshi
AU - Nagata, Izumi
N1 - Publisher Copyright:
© 2017 by the Congress of Neurological Surgeons.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Background: Definitive preoperative predictors of cerebral hyperperfusion following carotid artery stenting are yet to be established. Objective: To determine the preprocedural risk factors for cerebral hyperperfusion phenomenon (CHP) following carotid artery stenting. Methods: Patients 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. Results: Out 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. Conclusion: Combined use of cerebral angiography and SPECT may obviate the need for acetazolamide challenge to predict the risk of CHP following carotid artery stenting.
AB - Background: Definitive preoperative predictors of cerebral hyperperfusion following carotid artery stenting are yet to be established. Objective: To determine the preprocedural risk factors for cerebral hyperperfusion phenomenon (CHP) following carotid artery stenting. Methods: Patients 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. Results: Out 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. Conclusion: Combined use of cerebral angiography and SPECT may obviate the need for acetazolamide challenge to predict the risk of CHP following carotid artery stenting.
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U2 - 10.1093/neuros/nyx041
DO - 10.1093/neuros/nyx041
M3 - Article
AN - SCOPUS:85042099328
SN - 0148-396X
VL - 81
SP - 512
EP - 519
JO - Neurosurgery
JF - Neurosurgery
IS - 3
ER -