title: Stenotic transverse sinus predisposes to poststenting hyperperfusion syndrome as evidenced by quantitative analysis of peritherapeutic cerebral circulation time.
abstract: OBJECTIVE
  Hyperperfusion syndrome is a devastating complication of carotid stent placement. The shortening of cerebral circulation time after stent placement is seen as a good indicator of the development of hyperperfusion syndrome. The purpose of our study was to evaluate whether patients with ipsilateral transverse sinus stenosis are prone to having shortened cerebral circulation time after stent placement, subsequently leading to the possible development of hyperperfusion syndrome.
  
  
  METHODS
  Forty-nine patients with >70% unilateral carotid stenosis undergoing stent placement were recruited for analysis. Group A consisted of patients with a stenotic ipsilateral transverse sinus >50% greater than the diameter of the contralateral transverse sinus; the remaining patients were in group B. Quantitative DSA was used to calculate cerebral circulation time. Cerebral circulation time was defined as the time difference between the relative time to maximal intensity of ROIs in the proximal internal carotid artery and the internal jugular vein. ΔCCT was defined as cerebral circulation time before stent placement minus cerebral circulation time after stent placement. ΔCCT, white matter hyperintensity signals, and sulcal effacement in MR imaging were compared between the 2 groups.
  
  
  RESULTS
  ΔCCT was significantly shorter in group A (0.65 ± 1.3) than in group B (-0.12 ± 1.4). Three patients had white matter hyperintensity signals in group A, and 1 developed hyperperfusion syndrome. Group B showed no MR imaging signs of hyperperfusion syndrome.
  
  
  CONCLUSIONS
  Ipsilateral hypoplastic transverse sinus was associated with prolonged cerebral circulation time before stent placement and greatly shortened cerebral circulation time after stent placement. Inadequate venous drainage might play a role in impaired cerebral autoregulation and might influence the development of poststenting hyperperfusion syndrome.
authors.affiliation: From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), National Yang Ming University, Taipei, Taiwan.
authors.forename: C-J
authors.initials: CJ
authors.lastname: Lin
authors.affiliation: From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), National Yang Ming University, Taipei, Taiwan.
authors.forename: F-C
authors.initials: FC
authors.lastname: Chang
authors.affiliation: Imaging Research Center (F.-Y.T., D.Y.-T.C.), Taipei Medical University, Taipei, Taiwan ftsai@uci.edu ftsai@tmu.edu.tw.
authors.forename: F-Y
authors.initials: FY
authors.lastname: Tsai
authors.affiliation: From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), National Yang Ming University, Taipei, Taiwan.
authors.forename: W-Y
authors.initials: WY
authors.lastname: Guo
authors.affiliation: From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), National Yang Ming University, Taipei, Taiwan.
authors.forename: S-C
authors.initials: SC
authors.lastname: Hung
authors.affiliation: Imaging Research Center (F.-Y.T., D.Y.-T.C.), Taipei Medical University, Taipei, TaiwanDepartment of Medical Imaging (D.Y.-T.C.), Shuang-Ho Hospital, New Taipei City, Taiwan.
authors.forename: D Y-T
authors.initials: DY
authors.lastname: Chen
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine (C.-H.L.), National Taiwan University, Taipei, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Lin
authors.affiliation: From the Department of Radiology (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine (C.-J.L., F.-C.C., W.-Y.G., S.-C.H., C.-Y.C.), National Yang Ming University, Taipei, Taiwan.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Chang
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000150:complications / Q000628:therapy*; D002539:Cerebral Arterial Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D020227:Lateral Sinus Thrombosis / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D019990:Perioperative Care; D063177:Pulse Wave Analysis / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents / Q000009:adverse effects*; D013577:Syndrome