Abstract TP139: Usefulness of Staged Angioplasty for Carotid Artery Stenting

Abstract

Introduction: Hyperperfusion syndrome is one of the most serious complications after carotid revascularization. We report the efficacy of staged angioplasty (SAP) for patients with severely impaired cerebral vasoreactivity. Methods: From April 2008 to March 2012, seventeen of 83 patients with high-grade internal carotid artery stenosis were considered at high risk of postoperative hyperperfusion based on the results of preoperative single-photon emission computed tomography (SPECT) with acetazolamide. They were treated with SAP which consists of mild balloon angioplasty (1st stage) and carotid artery stenting one month later (2nd stage). Rest 123I-IMP SPECT was performed to evaluate hyperperfusion just after the procedure of each stage. Results: Before we induced SAP procedure, 1.9%(3 of 158) of patients treated with CAS had a hemorrhagic complication due to hyperperfusion. None of 17 patients treated with SAP had hyperperfusion phenomenon on SPECT, and a hemorrhagic complication. The mean rate of stenosis was 91% before treatment, 70% after 1st stage, 21% after 2nd stage. Although stenosis had been worsened during the period between 1st and 2nd stages in four patients, all patients showed satisfactory recovery of cerebral blood flow after 2nd stage. Conclusions: In selected patients, SAP is effective and relatively safe to decrease hyperperfusion syndrome after procedures. However, method to choose high-risk patient for postoperative hyperperfusion and protocol of treatment are still controversial.