Effectiveness of Staged Angioplasty for Avoidance of Cerebral Hyperperfusion Syndrome After Carotid Revascularization

Abstract

A multicenter, retrospective review was performed from October 2007 to March 2014. During this period, 523 patients (8%) from 44 Japanese centers were considered at high risk of cerebral hyperperfusion syndrome by the findings from single-photon emission computed tomography (SPECT) or other studies. Of 530 atherosclerotic lesions, 428 were treated by single-stage carotid artery stenting (CAS) and 102 by carotid artery angioplasty using a 3-mm-diameter balloon, followed by delayed, or staged, CAS (SAP) 2 to 4 weeks later. The preoperative mean carotid artery stenosis and SPECT parameters were worse in the SAP group than in the single-stage CAS group. All cases were performed via the transfemoral approach and embolic protection devices. The rate of cerebral hyperperfusion syndrome was significantly less in the SAP group (4%) compared with the single-stage CAS group (10%; P = .47). Multivariate analysis showed that SAP was negatively related to hyperperfusion syndrome. The composite rate of transient ischemic attack and ischemic stroke was about the same in both groups (9%). Carotid angioplasty followed by staged CAS might be effective for preventing hyperperfusion syndrome.