The Role of Perfusion Computed Tomography in the Prediction of Cerebral Hyperperfusion Syndrome

• Published in: PloS one Vol. 6; no. 5; p. e19886
• Main Authors: Chang, Chien Hung, Chang, Ting Yu, Chang, Yeu Jhy, Huang, Kuo Lun, Chin, Shy Chyi, Ryu, Shan Jin, Yang, Tao Chieh, Lee, Tsong Hai
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20.05.2011; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Angioplasty; Arteriosclerosis; Atherosclerosis; Blood; Blood flow; Blood pressure; Blood volume; Carotid arteries; Carotid artery; Carotid Stenosis - complications; Carotid Stenosis - surgery; Case-Control Studies; CAT scans; Cerebral blood flow; Cerebrovascular Circulation; Cerebrovascular Disorders - diagnosis; Cerebrovascular Disorders - etiology; Computation; Computed tomography; Demographics; Feasibility studies; Female; Health aspects; Hemorrhage; Hospitals; Humans; Male; Mathematical analysis; Medical imaging; Medical research; Medicine; Middle Aged; Morbidity; Mortality; Neurology; Patients; Perfusion; Perfusion Imaging; Postoperative Complications; Predictions; Prognosis; Regression analysis; Retrospective Studies; Risk analysis; Risk factors; Stenosis; Stents; Stroke; Studies; Syndrome; Tomography, X-Ray Computed; Veins & arteries; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0019886

Hyperperfusion syndrome (HPS) following carotid angioplasty with stenting (CAS) is associated with significant morbidity and mortality. At present, there are no reliable parameters to predict HPS. The aim of this study was to clarify whether perfusion computed tomography (CT) is a feasible and reliable tool in predicting HPS after CAS. We performed a retrospective case-control study of 54 patients (11 HPS patients and 43 non-HPS) with unilateral severe stenosis of the carotid artery who underwent CAS. We compared the prevalence of vascular risk factors and perfusion CT parameters including regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), and time to peak (TTP) within seven days prior to CAS. Demographic information, risk factors for atherosclerosis, and perfusion CT parameters were evaluated by multivariable logistic regression analysis. The rCBV index was calculated as [(ipsilateral rCBV - contralateral rCBV)/contralateral rCBV], and indices of rCBF and TTP were similarly calculated. We found that eleven patients had HPS, including five with intracranial hemorrhages (ICHs) of whom three died. After a comparison with non-HPS control subjects, independent predictors of HPS included the severity of ipsilateral carotid artery stenosis, 3-hour mean systolic blood pressure (3 h SBP) after CAS, pre-stenting rCBV index >0.15 and TTP index >0.22. The combination of severe ipsilateral carotid stenosis, 3 h SBP after CAS, rCBV index and TTP index provides a potential screening tool for predicting HPS in patients with unilateral carotid stenosis receiving CAS. In addition, adequate management of post-stenting blood pressure is the most important treatable factor in preventing HPS in these high risk patients.