title: Prediction of cerebral hyperperfusion syndrome after carotid artery stenting by CT perfusion imaging with acetazolamide challenge.
abstract: BACKGROUND
  Cerebral hyperperfusion syndrome (HPS) is an uncommon but serious complication of carotid artery stenting (CAS). The purpose of this study was to investigate the efficacy of CT perfusion imaging (CTP) with acetazolamide challenge to identify patients at risk for HPS after CAS.
  
  
  METHODS
  We retrospectively analyzed 113 patients who underwent CTP with rest and acetazolamide challenge before CAS. CTP maps were assessed for absolute and relative cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and change of each parameter before and after acetazolamide challenge. Patients were divided into two groups according to the HPS after the CAS. Receiver-operating characteristic (ROC) curve analysis was performed to determine the most accurate CTP parameter for the prediction of HPS.
  
  
  RESULTS
  Nine of 113 patients had HPS. There were significant differences for absolute and relative values of resting CBF (p = 0.001 and p = 0.026), resting MTT (p < 0.001 and p = 0.004), post-acetazolamide CBF (p < 0.001 and p = 0.001), post-acetazolamide MTT (p < 0.001 and p = 0.002), and % changes of CBF (p = 0.009) between the HPS and non-HPS groups. ROC curve analysis showed that the CTP parameters with the maximal area under the receiver-operating characteristic curve (AUC) for HPS was the absolute value of post-acetazolamide MTT (AUC 0.909) and the absolute value of resting MTT (AUC 0.896).
  
  
  CONCLUSIONS
  Pretreatment CTP with acetazolamide challenge could identify patients at risk for HPS after CAS. Although the CTP parameter that most accurately identified patients at risk for HPS was the absolute value of post-acetazolamide MTT, resting MTT was sufficiently accurate.
authors.affiliation: Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, 3-435, Kosugimachi, Nakahara-ku, Kawasaki, 211-0063, Japan. tomohide.yoshie.1215@marianna-u.ac.jp.
authors.forename: Tomohide
authors.identifier: http://orcid.org/0000-0001-9302-5511
authors.initials: T
authors.lastname: Yoshie
authors.affiliation: Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, 3-435, Kosugimachi, Nakahara-ku, Kawasaki, 211-0063, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Ueda
authors.affiliation: Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, 3-435, Kosugimachi, Nakahara-ku, Kawasaki, 211-0063, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Takada
authors.affiliation: Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, 3-435, Kosugimachi, Nakahara-ku, Kawasaki, 211-0063, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nogoshi
authors.affiliation: Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, 3-435, Kosugimachi, Nakahara-ku, Kawasaki, 211-0063, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Fukano
authors.affiliation: Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
mesh_terms: D000086:Acetazolamide; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology; D000072226:Computed Tomography Angiography / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D000086:Acetazolamide
keywords: Acetazolamide; CT perfusion; Carotid artery stenting; Hyperperfusion syndrome