摘要
Background:Hyperperfusion syndrome(HPS)is a rare but potentially a life-threatening complication after carotid artery angioplasty and stenting(CAS).Staged CAS has been an alternative to prevent HPS.Materials and methods:44 of 908 patients with high-grade internal carotid artery stenosis or near occlusion were at risk of HPS because of poor collateral flow and impaired cerebral blood flow(CBF).They were treated with first(stage 1),followed by a full CAS(stage 2)1 month later.Their 30-day outcomes were tabulated and analysed.Results:During follow-up,1 of the 44(2.2%)patients developed HPS immediately,3(7%)had postprocedural HPS(ie,transcranial Doppler(TCD)>120%)without clinical symptoms and 3(7%)required stenting at stage 1 for carotid dissections.After stage 1,there were significant improvement between the preprocedural and postprocedural CBF(0.98±0.06 vs 0.85±0.05,p<0.05),mean transit time(MTT;1.05±0.05 vs 1.15±0.05,p<0.05),time to peak(TTP;1.04±0.06 vs 1.20±0.06,p<0.05)on CT perfusion(CTP),and CBF(66.41±7.41 vs 44.44±6.43,p<0.05)on TCD.After stage 2,improvement was seen in CBF(1.01±0.07 vs 0.98±0.06,p<0.05),MTT(1.01±0.05 vs 1.05±0.05,p<0.05),TTP(0.99±0.06 vs 1.04±0.06,p<0.05)on CTP and CBF(66.41±7.41 vs 93.78±18.81,p<0.05)on TCD.2 had postoperative increase of middle cerebral artery mean flow velocity of 120%after stage 2 without clinical symptoms.Conclusion:Staged carotid artery stenting probably decreased the chance of developing HPS in this group of selected patients.Although requiring a 2-step intervention,staged CAS may be a safe and effective alternative.
