STAGED ANGIOPLASTY FOR CAROTID ARTERY STENOSIS TO PREVENT POSTOPERATIVE HYPERPERFUSION
STAGED ANGIOPLASTY FOR CAROTID ARTERY STENOSIS TO PREVENT POSTOPERATIVE HYPERPERFUSION
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DOI：
10.1227/01.neu.0000334046.41985.bb
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发表时间：
2009-03-01
期刊：
影响因子：
4.8
通讯作者：
Iwama, Toru
中科院分区：
文献类型：
--
作者：
Yoshimura, Shinichi;Kitajima, Hideomi;Iwama, Toru
目的：高灌注（HP）是颈动脉血运重建术后一种罕见但潜在的破坏性并发症。本报告描述了分期血管成形术（SAP）治疗颈动脉狭窄以预防颈动脉血运重建后HP的临床疗效。143例计划进行血管成形术的高度颈内动脉狭窄患者中有18例基于其严重受损的脑血流量（CBF）和脑血管反应性被认为具有术后HP的高风险，其使用乙酰唑胺的单光子发射计算机断层扫描测定。9例高危患者接受颈动脉支架植入术治疗，另外9例接受SAP治疗，其中包括使用小型球囊导管进行球囊血管成形术（第1阶段），然后在1至2个月后进行颈动脉支架植入术（第2阶段）。常规颈动脉支架组9例患者中5例（56%）在支架植入后即刻单光子发射计算机断层扫描显示HP现象，1例（11%）因HP引起癫痫持续状态。在SAP组中，接受SAP治疗的8例患者或1例因壁夹层而在第一阶段需要放置支架的患者均未出现术后HP现象或HP综合征。结论：SAP减少了选定患者进行这些手术后单光子发射计算机断层扫描上的HP现象。虽然需要额外的干预，SAP被认为是一个相对简单和有效的方法，以避免HP的高风险患者颈动脉血运重建后的HP。
OBJECTIVE: Hyperperfusion (HP) is a rare but potentially devastating complication after carotid revascularization. This report describes the clinical I efficacy of staged angio-plasty (SAP) for carotid artery stenosis to prevent HP after carotid revascularization.METHODS: Eighteen of 143 patients with high-grade internal carotid artery stenosis scheduled for angioplasty were considered at high risk of postprocedure HP based on their severely impaired cerebral blood flow (CBF) and cerebral vasoreactivity, which were determined using single-photon emission computed tomography with acetazolamide. Nine of the high-risk patients were treated with carotid artery stenting and the other 9 were treated with SAP, which consisted of balloon angioplasty with undersized balloon catheters (Stage 1) followed by carotid artery stenting 1 to 2 months later (Stage 2).RESULTS: In the regular carotid artery stenting group, 5 of 9 patients (56%) showed HP phenomenon on single-photon emission computed tomography just after stenting, and 1 patient (11%) developed status epilepticus owing to HP. In the SAP group, none of the 8 patients treated by SAP or the 1 patient who required stent placement during the first stage owing to a wall dissection developed postprocedure HP phenomenon or HP syndrome.CONCLUSION: SAP decreased the HP phenomenon on single-photon emission computed tomography after performing these procedures in selected patients. Although additional intervention is needed, SAP is considered a relatively simple and effective method to avoid HP in patients at high risk of HP after carotid revascularization.