Amplitude of Tissue Oxygenation Index Change Predicts Cerebral Hyperperfusion Syndrome during Carotid Artery Stenting

• Published in: World neurosurgery Vol. 99; pp. 548 - 555
• Main Authors: Park, Hun Soo, MD, Nakagawa, Ichiro, MD, PhD, Yokoyama, Shohei, MD, Motoyama, Yasushi, MD, PhD, Park, Young Su, MD, PhD, Wada, Takeshi, MD, PhD, Kichikawa, Kimihiko, MD, PhD, Nakase, Hiroyuki, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: Aged; Aged, 80 and over; Carotid artery stenting; Carotid Stenosis - surgery; Cerebrovascular Circulation; Endovascular Procedures; Female; Frontal Lobe - diagnostic imaging; Frontal Lobe - metabolism; Humans; Hyperperfusion syndrome; Male; Middle Aged; Near-infrared spectroscopy; Neurosurgery; Oxygen - metabolism; Postoperative Complications - epidemiology; Retrospective Studies; Risk Assessment; Spectroscopy, Near-Infrared; Stents; Syndrome; Tomography, Emission-Computed, Single-Photon; carotid endoarterectomy; near-infrared spectroscopy; magnetic resonance imaging; hyperperfusion syndrome; MRI; CBF; HPS; embolic protection devices; SPECT; carotid artery stenting; percutaneous transluminal angioplasty; DSA; NIRS; internal carotid artery; cerebrovascular reactivity; CEA; ACA; ICA; digital subtraction angiography; AI; MCA; tissue oxygenation index; middle cerebral artery; asymmetry index; TOI; CAS; acetazolamide; ACZ; cerebral blood flow; EPDs; PTA; anterior cerebral artery; CVR; single-photon emission computed tomography; rCBF; Carotid artery stenting; IMP; Near-infrared spectroscopy; rSO2; Hyperperfusion syndrome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.12.062

Abstract Objective Hyperperfusion syndrome (HPS) following carotid artery stenting (CAS) is a rare but serious complication. HPS is associated with preoperative hemodynamic impairment due to poor collateral flow and intraoperative cerebral ischemia. Filter-type embolic protection devices (EPDs) maintain anterograde carotid flow during CAS and somewhat prevent HPS. Early treatment of patients undergoing CAS and at risk for HPS is essential. Near-infrared spectroscopy (NIRS) allows non-invasive, real-time measurement of frontal lobe regional cerebral O2 saturation (TOI; tissue oxygenation index). Methods The perioperative amplitude of TOI was monitored in 130 patients undergoing CAS while using a filter-type EPD. Patients were retrospectively divided into good (n = 110) and poor/no cross flow groups (n = 20), and we compared the amplitude of the TOI change, correlation with ipsilateral regional cerebral blood flow, and clinical results. Results The HPS incidence was significantly higher in the poor/no cross flow group (P = 0.019). In two patients with HPS, the amplitude of the TOI change was V-shaped, with a decrease after post-dilatation and an increase above baseline 5 minutes after reperfusion. The TOI/baseline ratio was significantly decreased after internal carotid artery occlusion for post-dilatation in the ipsilateral hemisphere in the poor/no cross flow group (P < 0.05). Significant linear correlations were observed between TOI/baseline ratio changes and preoperative cerebrovascular reactivity and the postoperative asymmetry index (r = −0.346, P = 0.002, r = 0.613, P < 0.001, respectively). Conclusions The amplitude of the TOI change measured by NIRS was an excellent predictor of cerebral HPS after CAS.