Intentional Stent Stenosis to Prevent Hyperperfusion Syndrome After Carotid Artery Stenting for Extremely High-Grade Stenosis

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2020 Nov 13

PMID 33184067

Citations 3

Authors

T Mori

K Yoshioka

Y Tanno

S Kasakura

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Intracranial hemorrhage due to hyperperfusion syndrome is a severe carotid artery stent placement complication of extremely high-grade stenosis, causing hemodynamic insufficiency. To prevent hyperperfusion syndrome, we attempted intentional residual stent stenosis and implemented "gentle" carotid artery stent placement, defined as carotid artery stent placement using a closed-cell stent coupled with slight balloon predilation, without balloon postdilation. Gradual stent expansion was expected. We investigated the incidence of hyperperfusion syndrome and long-term outcomes after gentle carotid artery stent placement.

Materials And Methods: We included patients who underwent carotid artery stent placement for extremely high-grade stenosis from January 2015 to March 2019. We defined extremely high-grade stenosis as carotid stenosis with conventional angiographic "slow flow" and a reduced MCA signal intensity on MRA. A reduced MCA signal intensity was defined as MCA with a relative signal intensity of <0.9 in the ipsilateral compared with the contralateral MCA. We evaluated the stent diameter, CBF on SPECT, hyperperfusion syndrome, and intracranial hemorrhage. We defined hyperperfusion syndrome as a triad of ipsilateral headache, seizure, and hemiparesis.

Results: Twenty-eight of the 191 patients met our inclusion criteria. After carotid artery stent placement, their median minimal stent diameter was 2.9 mm, which expanded to 3.9 mm at 4 months. Neither cerebral hyperperfusion syndrome nor intracranial hemorrhage occurred.

Conclusions: The gentle carotid artery stent placement strategy for intentional residual stent stenosis may prevent hyperperfusion syndrome in high-risk patients. Stents spontaneously dilated in 4 months.

Citing Articles

Post-Carotid Artery Stenting Hyperperfusion Syndrome in a Hypotensive Patient: Case Report and Systematic Review of Literature.

Zupan M, Perovnik M, Oblak J, Frol S Life (Basel). 2024; 14(11).

PMID: 39598270 PMC: 11595517. DOI: 10.3390/life14111472.

Predictors and Outcomes of Periprocedural Intracranial Hemorrhage after Stenting for Symptomatic Intracranial Atherosclerotic Stenosis.

Kang K, Gong P, Gao F, Mo D, Zhao X, Miao Z AJNR Am J Neuroradiol. 2024; 45(11):1716-1722.

PMID: 39389777 PMC: 11543066. DOI: 10.3174/ajnr.A8379.

Gradual Expansion of a Stent to Prevent Periprocedural Complications after Carotid Artery Stenting for Vulnerable Severe Stenotic Lesions with Intraplaque Hemorrhages: A Retrospective Observational Study.

Mori T, Yoshioka K, Tanno Y, Kasakura S Life (Basel). 2022; 12(1).

PMID: 35054523 PMC: 8781376. DOI: 10.3390/life12010131.

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