Stenotic Transverse Sinus Predisposes to Poststenting Hyperperfusion Syndrome as Evidenced by Quantitative Analysis of Peritherapeutic Cerebral Circulation Time

• Published in: American journal of neuroradiology : AJNR Vol. 35; no. 6; pp. 1132 - 1136
• Main Authors: Lin, C.- J., Chang, F.- C., Tsai, F.- Y., Guo, W.- Y., Hung, S.- C., Chen, D. Y.- T., Lin, C.- H., Chang, C.- Y.
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01.06.2014
• Subjects: Aged; Blood Flow Velocity; Blood Vessel Prosthesis - adverse effects; Brain; Carotid Stenosis - complications; Carotid Stenosis - therapy; Cerebral Arterial Diseases - etiology; Cerebral Arterial Diseases - pathology; Cerebral Arterial Diseases - physiopathology; Cerebrovascular Circulation; Female; Humans; Lateral Sinus Thrombosis - etiology; Lateral Sinus Thrombosis - pathology; Lateral Sinus Thrombosis - physiopathology; Magnetic Resonance Angiography - methods; Male; Perioperative Care; Pulse Wave Analysis - methods; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Stents - adverse effects; Syndrome
• DOI: 10.3174/ajnr.A3838
• ISSN: 0195-6108; 1936-959X

Hyperperfusion syndrome is a devastating complication of carotid stent placement. The shortening of cerebral circulation time after stent placement is seen as a good indicator of the development of hyperperfusion syndrome. The purpose of our study was to evaluate whether patients with ipsilateral transverse sinus stenosis are prone to having shortened cerebral circulation time after stent placement, subsequently leading to the possible development of hyperperfusion syndrome. Forty-nine patients with >70% unilateral carotid stenosis undergoing stent placement were recruited for analysis. Group A consisted of patients with a stenotic ipsilateral transverse sinus >50% greater than the diameter of the contralateral transverse sinus; the remaining patients were in group B. Quantitative DSA was used to calculate cerebral circulation time. Cerebral circulation time was defined as the time difference between the relative time to maximal intensity of ROIs in the proximal internal carotid artery and the internal jugular vein. ΔCCT was defined as cerebral circulation time before stent placement minus cerebral circulation time after stent placement. ΔCCT, white matter hyperintensity signals, and sulcal effacement in MR imaging were compared between the 2 groups. ΔCCT was significantly shorter in group A (0.65 ± 1.3) than in group B (-0.12 ± 1.4). Three patients had white matter hyperintensity signals in group A, and 1 developed hyperperfusion syndrome. Group B showed no MR imaging signs of hyperperfusion syndrome. Ipsilateral hypoplastic transverse sinus was associated with prolonged cerebral circulation time before stent placement and greatly shortened cerebral circulation time after stent placement. Inadequate venous drainage might play a role in impaired cerebral autoregulation and might influence the development of poststenting hyperperfusion syndrome.