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Cerebral Hyperperfusion After Carotid Stenting: A Transcranial Doppler and SPECT Study

5th Surgical Clinic, Medical School, Aristotle University of Thessaloniki, Ippocrateio Hospital, Thessaloniki, Greece, gsfyr{at}yahoo.gr

Christos D. Karkos, MD, PhD

5th Surgical Clinic, Medical School, Aristotle University of Thessaloniki, Ippocrateio Hospital, Thessaloniki, Greece

Georgios Arsos, MD, PhD

Department of Nuclear Medicine, Medical School, Aristotle University of Thessaloniki, Ippocrateio Hospital, Thessaloniki, Greece

Charalampos Liasidis, MD, PhD

Department of Neurology, Ippocrateio Hospital, Thessaloniki, Greece

Athanassios S. Dimitriadis, MD, PhD

Department of Radiology, Medical School, Aristotle University of Thessaloniki AHEPA Hospital, Thessaloniki, Greece

Konstantinos O. Papazoglou, MD, PhD

5th Surgical Clinic, Medical School, Aristotle University of Thessaloniki, Ippocrateio Hospital, Thessaloniki, Greece

Thomas S. Gerassimidis, MD, PhD

5th Surgical Clinic, Medical School, Aristotle University of Thessaloniki, Ippocrateio Hospital, Thessaloniki, Greece

Aim: To document the incidence of symptomatic cerebral hyperperfusion after carotid stenting and to determine possible predisposing factors.

Methods: A prospective study of 29 consecutive patients undergoing carotid stenting. All patients underwent 1) brain computed tomography scan and magnetic resonance imaging, 2) transcranial Doppler including assessment of cerebrovascular reactivity of the ipsilateral middle cerebral artery and 3) 99m hexamethyl-propyleneamine oxime brain single photon emission computed tomography, before and after the procedure.

Results: A total of 5 patients developed adverse neurological events, 4 of them transient. Cerebral hyperperfusion was documented in two of these (6.9%). Both had exhausted cerebrovascular reactivity in the preoperative transcranial Doppler examination. No consistent pattern of interhemispheric asymmetry in brain perfusion was found in these patients.

Conclusions: Symptomatic cerebral hyperperfusion is not uncommon after carotid stenting. There seems to be a link between exhausted cerebrovascular reactivity of the ipsilateral middle cerebral artery and increased risk of cerebral hyperperfusion.

Key Words: carotid stenting • cerebral hyperperfusion • transcranial Doppler • cerebrovascular reactivity • 99m hexamethyl-propyleneamine oxime brain single photon emission computed tomography

This version was published on April 1, 2009

Vascular and Endovascular Surgery, Vol. 43, No. 2, 150-156 (2009)
DOI: 10.1177/1538574408324510


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