PT  - JOURNAL ARTICLE
AU  - T. Mori
AU  - K. Yoshioka
AU  - Y. Tanno
AU  - S. Kasakura
TI  - Intentional Stent Stenosis to Prevent Hyperperfusion Syndrome after Carotid Artery Stenting for Extremely High-Grade Stenosis
AID  - 10.3174/ajnr.A6853
DP  - 2021 Jan 01
TA  - American Journal of Neuroradiology
PG  - 132--137
VI  - 42
IP  - 1
4099  - http://www.ajnr.org/content/42/1/132.short
4100  - http://www.ajnr.org/content/42/1/132.full
SO  - Am. J. Neuroradiol.2021 Jan 01; 42
AB  - 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.AIasymmetric indexAVDO2arteriovenous difference of oxygenCAScarotid artery stent placementHIhemodynamic insufficiencyex-HSextremely high-grade carotid artery stenosisHPPhyperperfusion phenomenonHPShyperperfusion syndromeICHintracerebral hemorrhageMLDminimal luminal diameterOEFoxygen extraction fractionPSVpeak systolic velocityrCBFregional CBFSIsignal intensity