Effectiveness of staged angioplasty for avoidance of cerebral hyperperfusion syndrome after carotid revascularization

Hayakawa, Masayuki; Sugiu, Kenji; Yoshimura, Shinichi; Hishikawa, Tomohito; Yamagami, Hiroshi; Fukuda‐Doi, Mayumi; Sakai, Nobuyuki; Iihara, Koji; Ogasawara, Kuniaki; Oishi, Hidenori; Ito, Yasushi; Matsumaru, Yuji

doi:10.3171/2018.8.jns18887

Cited by 22 publications

(36 citation statements)

References 28 publications

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“…Additionally, the incidences of symptomatic ischemic complications caused by positive lesions on DWI did not differ significantly between the 2 groups. This is consistent with the results reported by Hayakawa et al 28 The administration of statins prior to CAS can significantly reduce the incidence of perioperative ischemic complications. A recent study reported the effect of atorvastatin in preventing ischemic complications after CAS, confirming that perioperative statin treatment is effective for reducing the number and incidence of ischemic lesions on DWI.…”

Section: Discussionsupporting

confidence: 93%

The safety and efficacy of staged angioplasty for treating carotid stenosis with a high risk of hyperperfusion: A single-center retrospective study

Wan

Wang

et al. 2020

Interv Neuroradiol

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Objective Hyperperfusion syndrome (HPS) following carotid artery stenting (CAS) is a rare but life-threatening complication. Staged angioplasty (SAP) is an alternative method that prevents HPS by preventing a sudden increase in cerebral blood flow. In this study, we investigated the safety and efficacy of SAP. Methods A total of 114 patients with carotid stenosis underwent CAS treatment in our hospital between September 2014 and September 2019. Patients with severe stenosis and poor collateral circulation shown on digital subtraction angiography (DSA) and hypoperfusion of the ipsilateral diseased blood vessel shown on computed tomography perfusion (CTP) imaging were subjected to SAP treatment (the SAP group), and other patients received regular CAS treatment (the RS group). Results Twenty-two patients (19.3%) with a high risk of HPS underwent SAP treatment, 1 of whom had carotid dissection after stage I balloon angioplasty and underwent regular CAS. This patient had HPS after surgery. None of the other patients in either group had HPS. One patient in the SAP group (4.5%) had hyperperfusion phenomenon (HPP) after stage II stenting, and 2 patients in the RS group (2.2%) had HPP. One patient in the SAP group (4.5%) and 4 patients in the RS group (4.3%) had symptomatic ischemic complications postoperatively. None of the differences between the 2 groups were statistically significant. Three patients had reduced modified Rankin Scale (mRS) scores at 90 days after discharge. Conclusion This research suggests that SAP appears to be an effective method to prevent HPS for patients with a high risk of HPS.

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Section: Discussionsupporting

confidence: 93%

The safety and efficacy of staged angioplasty for treating carotid stenosis with a high risk of hyperperfusion: A single-center retrospective study

Wan

Wang

et al. 2020

Interv Neuroradiol

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“…In one report, data from 525 patients (532 lesions, mean age 72.5±7.5 years, 74 women) were analyzed. 29 Scheduled procedures included staged angioplasty for 113 lesions and regular CAS for 419 lesions. The rate of CHS was lower in the staged angioplasty group than in the regular CAS group (4.4% vs 10.5%, p=0.047).…”

Section: Overview Of Cerebral Hyperperfusion Syndromementioning

confidence: 99%

Update on cerebral hyperperfusion syndrome

Lin

Liu

2020

J NeuroIntervent Surg

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Cerebral hyperperfusion syndrome (CHS) is a clinical syndrome following a revascularization procedure. In the past decade, neurointerventional surgery has become a standard procedure to treat stenotic or occluded cerebral vessels in both acute and chronic settings, as well as endovascular thrombectomy in acute ischemic stroke. This review aims to summarize relevant recent studies regarding the epidemiology, diagnosis, and management of CHS as well as to highlight areas of uncertainty. Extracranial and intracranial cerebrovascular diseases in acute and chronic conditions are considered. The definition and diagnostic criteria of CHS are diverse. Although impaired cerebrovascular autoregulation plays a major role in the pathophysiology of CHS, the underlying mechanism is still not fully understood. Its clinical characteristics vary in different patients. The current findings on clinical and radiological presentation, pathophysiology, incidence, and risk factors are based predominantly on carotid angioplasty and stenting studies. Hemodynamic assessment using imaging modalities is the main form of diagnosis although the criteria are distinct, but it is helpful for patient selection before an elective revascularization procedure is conducted. After endovascular thrombectomy, a diagnosis of CHS is even more complex, and physicians should consider concomitant reperfusion injury. Management and preventative measures, including intensive blood pressure control before, during, and after revascularization procedures and staged angioplasty, are discussed in detail.

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“…In this study, HPS or ICH occurred in three patients in the regular CAS group and no patients in the SAP group, but the difference was not statistically significant. Hayakawa et al 16 conducted a retrospective study in 44 Japanese centres to compare the efficacy of SAP and regular CAS. Among the 525 patients included in the analysis, the rate of cerebral hyperperfusion syndrome was lower in the SAP group than in the regular CAS group (4.4% vs 10.5%, respectively; p=0.047).…”

Section: Discussionmentioning

confidence: 99%

“…The ideal treatment staging interval is unclear, but most experts believe that the most appropriate interval is 2 weeks. 16 19–21 Therefore, it is feasible to shorten the staging interval to 2 weeks or to within 2 weeks and strive to complete the two procedures in one hospital to reduce medical costs.…”

Section: Discussionmentioning

confidence: 99%

“…The secondary endpoints within 30 days included HPP which was defined as an increase of CBF >100% than the baseline detected by transcranial Doppler (TCD) or CTP; procedure-related adverse events; myocardial infarction; major non-stroke haemorrhage (eg, epidural haemorrhage, intradural haemorrhage or other major systemic bleedings); death; stoke resulting in deformity. 16 …”

Section: Methodsmentioning

confidence: 99%

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Staged angioplasty versus regular carotid artery stenting in patients with carotid artery stenosis at high risk of hyperperfusion: a randomised clinical trial

Mo¹,

Jia²,

Shi

et al. 2020

Stroke Vasc Neurol

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Background and purposeHyperperfusion (HP) is a devastating complication associated with carotid artery stenting (CAS) or endarterectomy. The efficacy and safety of staged angioplasty (SAP) in patients with CAS at high risk of HP remains unclear. We sought to determine whether SAP is superior to regular CAS in patients with high risk of HP.MethodsA randomised, multicentre open-label clinical trial with blinded outcome assessment (STEP) was conducted. Patients with severe carotid stenosis at high risk of HP were randomly assigned (1:1) to the SAP or regular CAS group. The primary endpoint was hyperperfusion syndrome (HPS) and intracerebral haemorrhage (ICH) within 30 days after the procedure.ResultsFrom November 2014 to January 2017, a total of 64 patients were enrolled in 11 centres. 33 patients were allocated to the SAP group and 31 to the regular CAS group. At 30 days, the rate of primary endpoint was 0.0% (0/33) in the SAP group and 9.7% (3/31) in the regular CAS group (absolute risk reduction (ARR), 9.7%; 95% CI −20.1% to 0.7%; p=0.11). As one of the secondary endpoints, the incidence of HP phenomenon (HPP) was lower in the SAP group than the regular CAS group (0.0% vs 22.6%, ARR,−22.6%; 95% CI −36.8% to −10.2%; p=0.04).ConclusionThe rate of HPS and ICH was not significantly lower in SAP group; the extended secondary endpoint of HPP, however, significantly reduced, which suggested that SAP may be a safe and effective carotid revascularisation procedure to prevent HP.Trial registration numberNCT02224209.

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Effectiveness of staged angioplasty for avoidance of cerebral hyperperfusion syndrome after carotid revascularization

Cited by 22 publications

References 28 publications

The safety and efficacy of staged angioplasty for treating carotid stenosis with a high risk of hyperperfusion: A single-center retrospective study

The safety and efficacy of staged angioplasty for treating carotid stenosis with a high risk of hyperperfusion: A single-center retrospective study

Update on cerebral hyperperfusion syndrome

Staged angioplasty versus regular carotid artery stenting in patients with carotid artery stenosis at high risk of hyperperfusion: a randomised clinical trial

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