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AJNR - American Journal of Neuroradiology

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Factors Predictive of Cerebral Hyperperfusion after Carotid Angioplasty and Stent Placement

Yasuhiko Kaku^a, Shin-ichi Yoshimura^b and Jouji Kokuzawa^b

^a Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Japan
^b the Department of Neurosurgery, Gifu University School of Medicine, Japan

View larger version (41K): [in a new window]   FIG 1. Images obtained in an 83-year-old man with a minor, completed stroke. A, Pretreatment right carotid angiogram shows severe internal carotid artery stenosis at its origin (arrow), with delayed filling of the distal part of the artery. B, Pretreatment FLAIR image shows small ischemic lesions in the right posterior watershed area. C, Pretreatment 123I-IMP SPECT scan in the resting state shows severely decreased perfusion in the right cerebral hemisphere with an asymmetry index of 50.7%. D, Pretreatment SPECT scan obtained with an ACZ challenge shows an impaired cerebrovascular reserve of 11.1% in the right cerebral hemisphere.

View larger version (37K): [in a new window]   FIG 2. Images obtained in an 83-year-old man with cerebral hyperperfusion after carotid stent placement. A, Postprocedural carotid angiogram shows satisfactory dilatation of the right internal carotid artery with normalized distal blood flow. B, 99mTc-HMPAO SPECT scan obtained immediately after stent placement shows hyperperfusion in the right MCA territory, with an asymmetry index of 120.3% (arrow). C, 123I-IMP SPECT scan in the resting state obtained 7 days after stent placement shows prolonged hyperperfusion in the territory, with an asymmetry index of 108.1%. D, 123I-IMP SPECT scan obtained with an ACZ challenge 7 days after stent placement shows a slightly improved but still impaired cerebrovascular reserve of 13.4% in the right cerebral hemisphere.

View larger version (13K): [in a new window]   FIG 3. Sequential changes in the asymmetry index (AI). In the hyperperfusion group (A), the pretreatment index of 70.2% ± 25.2 increases to 116.0% ± 4.5 immediately after carotid stent placement and then decreases to 105.3% ± 4.1 7 days after the procedure (Asterisk indicates P < .01.) The index did not significantly change in the nonhyperperfusion group (B).

View larger version (12K): [in a new window]   FIG 4. Comparisons of patient age, pretreatment ipsilateral CVR, and asymmetry index (AI) between the hyperperfusion (HP) and nonhyperperfusion (non-HP) groups. Univariate analysis demonstrated significant differences between the groups for age (78.3 ± 4.16 vs 66.7 ± 7.8 years) A, pretreatment ipsilateral CVR (6.3% ± 5.7 vs 40.3% ± 20.1) B, and asymmetry index (70.2% ± 25.2 vs 91.1% ± 14.1). Asterisk indicates P < .05; double asterisk, P < .01.