Predictors of hyperperfusion syndrome after stent implantation in symptomatic intracranial atherosclerotic stenosis

Long Yan; Jia Song; Ying Yu; Zhikai Hou; Weilun Fu; Rongrong Cui; Min Wan; Xiaotong Xu; Ming Lv; Yongjun Wang; Zhongrong Miao; Xin Lou; Ning Ma

doi:10.21037/qims-22-682

Predictors of hyperperfusion syndrome after stent implantation in symptomatic intracranial atherosclerotic stenosis

Quant Imaging Med Surg. 2023 Feb 1;13(2):1048-1057. doi: 10.21037/qims-22-682. Epub 2022 Dec 19.

Authors

Long Yan^#^{1

2}, Jia Song^#^{1

2

3}, Ying Yu^#^{1

2

4}, Zhikai Hou^{1

2

4}, Weilun Fu^{1

2}, Rongrong Cui^{1

2

4}, Min Wan^{1

2}, Xiaotong Xu^{1

2}, Ming Lv^{1

2}, Yongjun Wang^{2

4}, Zhongrong Miao^{1

2}, Xin Lou⁵, Ning Ma^{1

2}

Affiliations

¹ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing, China.
³ Department of Neurology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou, China.
⁴ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁵ Department of Radiology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.

^# Contributed equally.

Abstract

Background: Hyperperfusion syndrome (HPS) is a serious complication after stent implantation in symptomatic intracranial atherosclerotic stenosis (ICAS). This study aims to explore the predictive value of preprocedural computed tomography perfusion (CTP) for HPS after intracranial stenting.

Methods: In this retrospective case-control study we collected data from consecutive patients from June 2012 to September 2019 who underwent stent implantation due to severe symptomatic ICAS. Patients who underwent CTP before the procedure were enrolled. CTP was postprocessed using the automated RAPID software to assess the preoperative cerebral perfusion. According to the presence or absence of HPS, the patients were classified into two groups: the HPS group and the non-HPS group. The baseline data, lesion characteristics, and preoperative CTP parameters between the two groups were compared. The receiver operating characteristic (ROC) curve analysis was performed to determine the optimal predictor of HPS.

Results: Among the 170 eligible patients, 6 patients (3.53%) had HPS, including 3 who presented with intracranial hemorrhages (ICHs), 1 who had dysphoria, 1 who had delirium, and 1 who had a headache. There were no significant differences in baseline and lesion characteristics between the HPS and non-HPS groups. Compared with the non-HPS group, the HPS group had a significantly higher volume of time-to-maximum (T_max) >4 s (429.5 vs. 93 mL; P=0.006) and T_max >6 s (200 vs. 0 mL; P=0.003). The optimal volume threshold for maximizing sensitivity in predicting HPS was 65.5 mL with T_max >4 s [area under the curve (AUC), 0.832; 95% confidence interval (CI): 0.650 to 1.000; P=0.006].

Conclusions: T_max >4 s volume may be a predictor of HPS after stent implantation in symptomatic ICAS. Further prospective studies should be conducted to confirm our conclusion.

Keywords: Intracranial atherosclerotic stenosis (ICAS); computed tomography perfusion (CTP); hyperperfusion syndrome (HPS); stent implantation.