Evaluation of changes of intracranial blood flow after carotid artery stenting using digital subtraction angiography flow assessment

Abstract

AIM:To evaluate the changes of intracranial blood flow after carotid artery stenting (CAS), using the flow assessment application "Flow-Insight", which was developed in our department. METHODS:Twenty patients treated by CAS participated in this study. We analyzed the change in concentration of the contrast media at the anterior-posterior and profile view image with the flow assessment application "Flow-Insight". And we compared the results with N-isopropyl-p-[123I] iodoamphetamine-single-photon emission computed tomography (IMP SPECT) performed before and after the treatment. RESULTS:From this study, 200% of the parameter "blood flow" change in the post/pre-treatment is suggested as the critical line of the hyperperfusion syndrome arise. Although the observed blood flow increase in the digital subtraction angiography system did not strongly correlate with the rate of increase of SPECT, the "Flow-Insight" reflected the rate of change of the vessels well. However, for patients with reduced reserve blood flow before CAS, a highly elevated site was in agreement with the site analysis results. CONCLUSION:We concluded that the cerebral angiography flow assessment application was able to more finely reveal hyperperfusion regions in the brain after CAS compared to SPECT. Core tip: Hyperperfusion syndrome is a relatively rare, but potentially serious, complication of carotid revascularization procedures. It is important to detect the excessive increase blood flow after treatment as soon as possible. We found that, although the observed blood flow increase in the digital subtraction ORIGINAL ARTICLE Basic Studyangiography system did not strongly correlate with the rate of increase of single-photon emission computed tomography before and after carotid artery stenting, the digital subtraction angiography flow assessment application more finely reflected the rate of change of the vessels well.Wada H, Saito M, Kamada K. Evaluation of changes of intracranial blood flow after carotid artery stenting using digital subtraction angiography flow assessment. World J Radiol 2015; 7(2): 45-51 Available from:

Changes in cerebral perfusion in patients undergoing revascularization of carotid artery stenosis

“…Изменения церебральной перфузии, выявленные на дооперационном этапе, могут быть значимы при определении риска возможных осложнений хирургического лечения, например синдрома церебральной гиперперфузии. Данное осложнение характеризуется значительным повышением ипсилатерального мозгового кровотока после хирургической реканализации брахицефальных артерий, превышающем метаболические потребности мозговой ткани [59]. Синдром церебральной гиперперфузии значительно ухудшает прогноз пациентов [59], способствуя повышению частоты инсультов.…”

“…Данное осложнение характеризуется значительным повышением ипсилатерального мозгового кровотока после хирургической реканализации брахицефальных артерий, превышающем метаболические потребности мозговой ткани [59]. Синдром церебральной гиперперфузии значительно ухудшает прогноз пациентов [59], способствуя повышению частоты инсультов. Развитие такого осложнения, как инсульт, в группе пациентов, перенесших эпизод гиперперфузии, в 10 раз выше, чем среди больных, послеоперационный период которых протекал без подобных гемодинамических нарушений [60].…”

Video-based education improves the image quality of diagnostic percutaneous cerebral angiography among elderly patients

“…Digital subtraction angiography (DSA) is considered the gold standard for cerebral vasculature observation [ 2 ]. It is the first step during neurointerventional procedures, for example, endovascular thrombectomy and carotid artery stenting [ 3 , 4 ]. However, patients sometimes cannot cooperate with the operation process, keeping still when they receive radiological assessment, for example, magnetic resonance imaging (MRI) [ 5 , 6 ].…”