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Original research
Prediction of hyperperfusion phenomenon after carotid artery stenting and carotid angioplasty using quantitative DSA with cerebral circulation time imaging
  1. Keita Yamauchi1,
  2. Yukiko Enomoto1,
  3. Katharina Otani2,
  4. Yusuke Egashira1,
  5. Toru Iwama1
  1. 1Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan
  2. 2AT Innovation, Siemens Healthcare K.K, Tokyo, Japan
  1. Correspondence to Dr Keita Yamauchi, Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu 501/1194, Japan; keitasbrt0326{at}


Background Hyperperfusion syndrome after carotid interventions has a low incidence but it can lead to morbidity and mortality.

Objective To evaluate the usefulness of quantitative DSA for predicting hyperperfusion phenomenon (HPP) after carotid artery stenting and angioplasty.

Methods Thirty-three consecutive patients with carotid stenosis treated with carotid artery stenting or angioplasty between February 2014 and August 2016 were included. Color-coded digital subtraction angiograms showing the time to maximum contrast intensity of each image pixel were obtained from conventional DSA before and after procedures. The cerebral circulation time (CCT) was defined as the difference in the relative time to maximum intensity between arterial and venous regions of interest set on the angiograms. HPP was diagnosed straight after the procedure with qualitative 123I-IMP single-photon emission CT (SPECT). Cut-off points for detecting HPP for preprocedural CCT and periprocedural change of CCT were assessed by receiver operating characteristic analysis using 123I-IMP SPECT as reference standard.

Results 123I-IMP SPECT showed HPP in 4 of 33 patients. In these 4 patients, preprocedural prolongation of CCT (13.0±6.1 vs 7.2±1.3 s; p<0.001) was seen compared with patients without HPP as well as larger periprocedural changes of CCT (5.9±5.7 vs 0.5±1.3 s; p<0.001). The optimal cut-off points of preprocedural CCT and change of CCT for predicting HPP were 8.0 s (100% sensitivity, 69% specificity) and 3.2 s (75% sensitivity, 100% specificity), respectively.

Conclusions Preprocedural prolongation and greater periprocedural change of CCT are associated with the occurrence of HPP. Periprocedural evaluation of CCT may be useful for predicting HPP.

  • angiography
  • angioplasty
  • stent

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  • Contributors KY: drafting of manuscript, study design, data analysis. YEn: study design, data collection, revision of the drafted manuscript, KO: revision of the drafted manuscript. YEg: data collection. TI: study design, revision of the drafted manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was obtained from the institutional review board of Gifu University Graduate School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.