Abstract TP123: Efficacy of Staged Angioplasty to Prevent Cerebral Hyperperfusion Syndrome After Endovascular Revascularization for Carotid Artery Stenosis

Abstract

Background and aim: Cerebral hyperperfusion syndrome (CHS) including intracranial hemorrhage (ICH) is a serious complication after carotid artery stenting (CAS). Staged angioplasty (SAP), undersized-balloon angioplasty followed by delayed CAS, was reported to be a potential preventable method against CHS. The aim of this study was to clarify the efficacy of SAP to prevent CHS after endovascular carotid revascularization for high-risk patients of CHS. Methods: The STOP CHS study is a multicenter, retrospective study which registered 535 high-risk patients of CHS from 45 Japanese centers, who underwent regular CAS, SAP or angioplasty performed by board-certified neurointerventionists between October 2007 and March 2014. Selection of high-risk patients of CHS was based on imaging tests, such as single-photon emission computed tomography with acetazolamide. We investigated the cumulative periprocedural rates of CHS, ICH and major adverse event (MAE: stroke, myocardial infarction and death) of patients scheduled for regular CAS or SAP (intention-to-treat [ITT] population) and the relationship between SAP and the cumulative incidence of CHS in ITT and as-treated (AT) populations (patients who underwent regular CAS or SAP). Results: A total of 525 patients (532 lesions, 74 women, 72.5±7.5 years old) was included. Angiographic stenosis was 86.2±9.2% and 337 lesions were symptomatic. Scheduled procedures were regular CAS in 419 lesions and SAP in 113 lesions, and final procedures were regular CAS in 428 lesions, SAP in 102 lesions and angioplasty in 2 lesions. The cumulative event rates were CHS in 9.2%, ICH in 4.3% and MAE in 11.5%, and these were higher in patients scheduled for regular CAS than in patients scheduled for SAP(10.5 % vs 4.4%, 5.3% vs 0.9% and 12.9% vs 6.2% with each p-value <0.05, respectively). After multivariate adjustment, schedule for SAP was negatively related to the cumulative incidence of CHS (OR, 0.25; 95%CI, 0.09-0.73). Same applied to implementation of SAP in AT population (OR, 0.28; 95%CI, 0.10-0.82). Conclusion: The cumulative periprocedural event rates of high-risk patients of CHS scheduled for regular CAS or SAP were actually high. SAP was a negative predictor of CHS in both ITT and AT populations.