Abstract
Background: Cerebral hyperperfusion syndrome (CHS) sometimes occurs after carotid revascularization in patients with severe hemodynamic failure. The incidence of CHS following carotid revascularization is not high. However, once it occurs, it may result in disabled clinical outcome. Therefore, it is very important to anticipate CHS. To anticipate CHS, single-photon emission computed tomography (SPECT) or PET may be useful, but it is impractical for all patients. Purpose: The purpose of our study was to investigate whether or not global oxygen extraction fraction (OEF) by blood sampling anticipated CHS following carotid artery stenting (CAS). Methods: When patients underwent elective CAS from September 2010 to June 2014, we performed blood sampling for OEF calculation before and immediately after elective CAS. Elective CAS was defined as CAS in asymptomatic patients or CAS in patients who experienced a last ischemic attack 30 days or more previously. Data were collected prospectively. OEF was calculated from arteriovenous oxygen difference as follows: OEF = (Ca02-Cv02)/Ca02 where Ca02 is arterial oxygen content and CvO2 is the jugular vein oxygen content. We evaluated baseline features of patients, pre-CAS OEF, post-CAS OEF and the occurrence of CHS. Results: In overall 131 patients, the median pre-CAS OEF was 0.41 (0.37-0.46; IQR), and median post-CAS OEF was 0.42 (0.38-0.47; IQR). Seven patients presented CHS. Between the two groups with and without CHS, there were no differences in patient characteristics. Between the two groups, there were not statistically significant differences of pre-CAS OEF (0.47 vs 0.41). However, patients in CHS group had higher post-CAS OEF than patients in non_CHS group (0.51 vs 0.42) (Mann-Whitney’s U test, p<0.05). Binary logistic regression analysis demonstrated that post-CAS OEF {relative risk; (95%CI); 1.12 (1.01-1.25), p<0.05} was an independent predictor of CHS. The area under the ROC curve for the post-CAS OEF for probable CHS diagnosis was 0.79 and the cut-off value was 50% (sensitivity of 86% and specificity of 88%) for probable CHS. Increase of post-CAS OEF was significantly related to probable CHS. Conclusion: Elevation of blood sampling OEF immediately after CAS anticipated post-CAS CHS.
Published Version
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