The Preprocedural Factors Of Cerebral Hyperperfusion Syndrome After Carotid Artery Stenting

Objective: To investigate the preprocedural factors of cerebral hyperperfusion syndrome(CHS)after carotid artery stenting(CAS).Methods: We collected 105 patients who underwent preprocedural single-photon emission computed tomography(SPECT)and carotid artery stenting.The clinical data and imaging parameters of 105 patients were retrospectively analyzed in this study.The patients were divided into hyperperfusion group(n=8)and non-hyperperfusion group(n=97)according to the postoperatively hyperperfusion syndrome.Results: In univariate analysis,the clinical data were compared between the two groups,the results showed that there were no significant differences in age,sex,history of hypertension,history of hyperlipidemia,drinking history,smoking history,heart disease history,lesion side and presence of ischemic symptoms(P>0.05,table 1);compared with the non-hyperperfusion group,the proportion of patients with diabetes in the hyperperfusion group was higher,and the degree of carotid stenosis was more severe(P<0.05,table 1).The imaging parameters of the two groups were analyzed: compared with the non-hyperperfusion groups,the patients in the hyperperfusion group have lower asymmetry index(AI)and cerebral blood flow(CBF)of the lesion side before the operation,and the ability of collateral circulation compensation was worse(P<0.05,table 2).On multivariate logistic regression analysis,history of diabetes(odds ratio [OR] 1.68,95% confidence interval [CI] 1.098~2.569,P=0.022),asymmetry index on SPECT(odds ratio [OR] 0.305,95% confidence interval [CI] 0.117~0.797,P=0.015)and the ability of collateral circulation compensation(odds ratio [OR] 0.002,95% confidence interval [CI] 0.000-0.358,P=0.019)were independent factors of CHS after CAS.Conclusion: History of diabetes,asymmetry index and the ability of collateral circulation compensation were independent factors of CHS after CAS.Fully understand the history of diabetes before operation,detect the asymmetry index by SPECT and evaluate the ability of collateral circulation compensation by DSA to predict the occurrence of postoperative CHS has important significance.