Utility of Near-infrared Spectroscopy Monitoring in the Management of Hyperperfusion Syndrome after Intracranial Carotid Artery Stenting

Abstract

Cerebral hyperperfusion syndrome (HPS) is a rare complication of carotid endarterectomy (CEA) and stenting. There are only a few case reports about HPS after intracranial stenting, and its clinical course remains unclear. We report an unusual case of HPS after intracranial internal carotid artery (ICA) stenting. An 87-year-old woman underwent uneventful balloon angioplasty for the right intracranial ICA one year ago; then she presented with restenosis at the same arterial location. She then underwent an ICA stent placement procedure. Preoperative cerebral blood flow (CBF) studies revealed hemodynamic ischemia. At the time of surgery, the stenotic lesion was near-occlusion. Twelve hours after the successful stenting procedure, the patient became restless, and near-infrared spectroscopy (NIRS) indicated a blood flow increase to the affected side. Arterial spin labeling (ASL) imaging performed on the same day showed high signal intensity only in the right hemisphere. She was treated with sedation, blood pressure control, and minocycline hydrochloride administration. Because of the strict management under continuous monitoring with NIRS, her symptoms gradually improved over the next 6 days. The right-to-left difference observed with ASL imaging resolved 6 days after surgery, and she was discharged with no neurological deficit. This case highlights the utility of NIRS monitoring in the management of HPS after intracranial stenting.

Optical imaging and spectroscopy for the study of the human brain: status report

“… 425 – 427 In addition, optical measurements can be predictive of cerebral hyperperfusion syndrome (a rare but critical complication in ICAD patients who undergo surgery) after both carotid endarterectomy 428 and carotid artery stenting. 429 Similarly, NIRS/DCS has the potential to provide valuable prognostic information during recanalization induced by mechanical thrombectomy in acute stroke patients. 394 , 398 Other emerging applications include optical guidance of extracorporeal perfusion to optimize brain health during cardiac surgery and critical care.…”

Cerebral hyperperfusion syndrome after intracranial stenting: Case report and systematic review

“…These flow alterations can be also monitored with intraoperative near-infrared spectroscopy (NIRS) 13 or MCA mean flow velocies (Vm) measured by transcranial Doppler (TCD). 14 In our opinion, the association between angiographic findings and intraoperative monitoring with NIRS 15 or MCA Vm measured by TCD 13 might play a role in identifying patients at risk of CHS.…”

“…11 After treatment there is an overload of blood flow in distal territories and some angiographic findings related to this phenomenon might suggest disruption of cerebral autoregulation, 12 as in our case: increased diameter of arterial branches, prominent capillary blush and early draining veins of the treated territories. These flow alterations can be also monitored with intraoperative near-infrared spectroscopy (NIRS) 13 or MCA mean flow velocies (Vm) measured by transcranial Doppler (TCD). 14 In our opinion, the association between angiographic findings and intraoperative monitoring with NIRS 15 or MCA Vm measured by TCD 13 might play a role in identifying patients at risk of CHS.…”