Utility of Near-infrared Spectroscopy Monitoring in the Management of Hyperperfusion Syndrome after Intracranial Carotid Artery Stenting.
Utility of Near-infrared Spectroscopy Monitoring in the Management of Hyperperfusion Syndrome after Intracranial Carotid Artery Stenting.
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DOI：
10.2176/nmccrj.cr.2020-0003
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Suda Y
中科院分区：
文献类型：
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作者：
Togashi S;Shimizu H;Suda Y
脑高灌注综合征(HPS)是颈动脉内膜剥脱术(CEA)和支架置入术的罕见并发症。目前有关颅内支架置入术后HPS的病例报道较少，其临床过程尚不清楚。我们报告一例颈内动脉(ICA)支架置入术后发生HPS的罕见病例。一位87岁的女性在一年前接受了右侧颈内动脉球囊血管成形术，随后在相同的动脉位置出现了再狭窄。然后，她接受了ICA支架置入程序。术前脑血流量(CBF)检查显示血流动力学缺血。手术时，狭窄的病变接近闭塞。支架植入成功12小时后，患者变得焦躁不安，近红外光谱(NIRS)显示流向患侧的血流量增加。同一天进行的动脉自旋标记(ASL)成像仅显示右侧大脑半球高信号。她接受了镇静、血压控制和盐酸米诺环素的治疗。由于在NIRS的持续监测下进行了严格的管理，在接下来的6天里，她的症状逐渐改善。ASL成像观察到的从右到左的差异在手术后6天消失，她出院时没有神经功能障碍。本病例强调了近红外光谱监测在颅内支架置入术后HPS治疗中的作用。
Cerebral hyperperfusion syndrome (HPS) is a rare complication of carotid endarterectomy (CEA) and stenting. There are only a few case reports about HPS after intracranial stenting, and its clinical course remains unclear. We report an unusual case of HPS after intracranial internal carotid artery (ICA) stenting. An 87-year-old woman underwent uneventful balloon angioplasty for the right intracranial ICA one year ago; then she presented with restenosis at the same arterial location. She then underwent an ICA stent placement procedure. Preoperative cerebral blood flow (CBF) studies revealed hemodynamic ischemia. At the time of surgery, the stenotic lesion was near-occlusion. Twelve hours after the successful stenting procedure, the patient became restless, and near-infrared spectroscopy (NIRS) indicated a blood flow increase to the affected side. Arterial spin labeling (ASL) imaging performed on the same day showed high signal intensity only in the right hemisphere. She was treated with sedation, blood pressure control, and minocycline hydrochloride administration. Because of the strict management under continuous monitoring with NIRS, her symptoms gradually improved over the next 6 days. The right-to-left difference observed with ASL imaging resolved 6 days after surgery, and she was discharged with no neurological deficit. This case highlights the utility of NIRS monitoring in the management of HPS after intracranial stenting.