Staged angioplasty for carotid artery stenosis to prevent postoperative hyperperfusion.
OBJECTIVE
Hyperperfusion (HP) is a rare but potentially devastating complication after carotid revascularization. This report describes the clinical efficacy of staged angioplasty (SAP) for carotid artery stenosis to prevent HP after carotid revascularization.


METHODS
Eighteen of 143 patients with high-grade internal carotid artery stenosis scheduled for angioplasty were considered at high risk of postprocedure HP based on their severely impaired cerebral blood flow (CBF) and cerebral vasoreactivity, which were determined using single-photon emission computed tomography with acetazolamide. Nine of the high-risk patients were treated with carotid artery stenting and the other 9 were treated with SAP, which consisted of balloon angioplasty with undersized balloon catheters (Stage 1) followed by carotid artery stenting 1 to 2 months later (Stage 2).


RESULTS
In the regular carotid artery stenting group, 5 of 9 patients (56%) showed HP phenomenon on single-photon emission computed tomography just after stenting, and 1 patient (11%) developed status epilepticus owing to HP. In the SAP group, none of the 8 patients treated by SAP or the 1 patient who required stent placement during the first stage owing to a wall dissection developed postprocedure HP phenomenon or HP syndrome.


CONCLUSIONS
SAP decreased the HP phenomenon on single-photon emission computed tomography after performing these procedures in selected patients. Although additional intervention is needed, SAP is considered a relatively simple and effective method to avoid HP in patients at high risk of HP after carotid revascularization.
Yoshimura
Shinichi
S
Department of Neurosurgery, Graduate School of Medicine, Gifu University, Gifu, Japan. s- yoshi@gifu- u.ac.jp
Kitajima
Hideomi
H
Enomoto
Yukiko
Y
Yamada
Kiyofumi
K
Iwama
Toru
T
D000086:Acetazolamide; D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001794:Blood Pressure / Q000502:physiology; D016893:Carotid Stenosis / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000517:prevention & control*; D004232:Diuretics; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D020367:Iofetamine; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D019275:Radiopharmaceuticals; D015607:Stents; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D004232:Diuretics; D010975:Platelet Aggregation Inhibitors; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D020367:Iofetamine; D000086:Acetazolamide