Abstract 2355: 2d Perfusion Color Mapping Can Predict Hyperperfusion Syndrome After Carotid Artery Stenting
Background: Hyperperfusion syndrome (HPS) is one of the most important complications during carotid artery stenting (CAS), which presents headache, seizure, focal neurological deficits due to intracerebral hemorrhage. It is essential to predict HPS because of its high morbidity or mortality. 2D perfusion color mapping (2DPCoM) enables to clarify cerebral perfusion status using only digital subtraction angiography (DSA) and its workstations. We report 2DPCoM can predict HPS.
Materials and Methods: 778 patients who had performed CAS have registered. All of the patients were analyzed with SPECT before and after CAS, including acetazolamide study. Transcranial doppler (TCD) have been performed before, during, and after CAS if possible. HPS was defined neurological deficits and intracerebral or subarachnoid hemorrhage with CT or MRI. DSA was performed with Allura Xper FD20/10 (Philips). 2DPCoM was analyzed with 6ml/sec contrast medium infusion from common carotid artery for 1 second. Maximum enhancement, start to peak, average wash-in rate (AWR) , Area-under-curve (AUC), mean transit time (MTT) were revealed. The data were compared with SPECT and TCD.
Results: 6/778 cases have presented HPS. All of the patients manifested misery perfusion (Powers stage 2) before CAS with SPECT. Mean middle cerebral artery flow velocity markedly increased after CAS with SPECT. 2DPCoM showed remarkable hyperperfusion state after CAS, especially MTT. MTT of all HPS cases dramatically changed >25% before and after the procedure.
Discussion: 2DPCoM has a lot of potential for evaluating cerebral hemodynamics with great ease compared with SPECT or TCD. It needs no more devices or drugs, needs only ‘one injection, one click, and one minute’. It might be useful for intracranial percutaneous transluminal angioplasty/stenting, symptomatic vasospasm following subarachnoid hemorrhage, and some other hemodynamic diseases.
Conclusion: 2D perfusion color mapping requires only one more infusion. It needs no more devices and one-click analysis within less than 1 minute. It is very useful modality during CAS for analyzing cerebral perfusion status.
- © 2012 by American Heart Association, Inc.