title: Prediction of Cerebral Hyperperfusion After Carotid Artery Stenting by Cerebral Angiography and Single-Photon Emission Computed Tomography Without Acetazolamide Challenge.
abstract: BACKGROUND
  Definitive preoperative predictors of cerebral hyperperfusion following carotid artery stenting are yet to be established.
  
  
  OBJECTIVE
  To determine the preprocedural risk factors for cerebral hyperperfusion phenomenon (CHP) following carotid artery stenting.
  
  
  METHODS
  Patients undergoing preprocedural single-photon emission computed tomography (SPECT) and cerebral angiography prior to their first carotid artery stenting were monitored for occurrence of CHP. In addition to patient characteristics, we investigated imaging parameters, such as cerebral blood flow, cerebral vasoreactivity, and asymmetry index on SPECT, and presence of near occlusion and leptomeningeal anastomosis on cerebral angiography.
  
  
  RESULTS
  Out of 100 patients (mean age: 73.0 ± 7.6 years; 85 men), 9 developed CHP. On multivariate logistic regression analysis, asymmetry index (%) on SPECT (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.70-0.93, P = .003) and presence of leptomeningeal anastomosis on cerebral angiography (OR 72.1, 95% CI 3.52-1480, P = .006) were independent predictors of CHP.
  
  
  CONCLUSIONS
  Combined use of cerebral angiography and SPECT may obviate the need for acetazolamide challenge to predict the risk of CHP following carotid artery stenting.
authors.affiliation: Department of Neurosurgery, Kochi Health Sciences Center, Kochi City, Kochi Prefecture, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ohta
authors.affiliation: Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake City, Aichi Prefecture, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakahara
authors.affiliation: Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka Prefecture, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka Prefecture, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Ishibashi
authors.affiliation: Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka Prefecture, Japan.
authors.forename: Haruka
authors.initials: H
authors.lastname: Miyata
authors.affiliation: Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka Prefecture, Japan.
authors.forename: Hidehisa
authors.initials: H
authors.lastname: Nishi
authors.affiliation: Department of Comprehensive Strokology, Fujita Health University School of Medicine, Toyoake City, Aichi Prefecture, Japan.
authors.forename: Sadayoshi
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu City, Fukuoka Prefecture, Japan.
authors.forename: Izumi
authors.initials: I
authors.lastname: Nagata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D015427:Reperfusion Injury / Q000453:epidemiology*; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
keywords: Carotid artery stenting; Carotid stenosis; Cerebral hyperperfusion