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Right arrow Near Infrared Spectroscopy (NIRS)
NEUROLOGY 2009;72:1512-1518
© 2009 American Academy of Neurology

Near-infrared spectroscopy in carotid artery stenting predicts cerebral hyperperfusion syndrome

S. Matsumoto, MD, I. Nakahara, MD, T. Higashi, MD, Y. Iwamuro, MD, Y. Watanabe, MD, K. Takahashi, MD, M. Ando, MD, M. Takezawa, MD and J. I. Kira, MD

From the Department of Neurosurgery (S.M., I.N., T.H., Y.I., Y.W., K.T., M.A., M.T.), Kokura Memorial Hospital; and Department of Neurology (J.-I.K.), Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Address correspondence and reprint requests to Dr. Shoji Matsumoto, Department of Neurosurgery, Kokura Memorial Hospital, 1-1 Kifunemachi, Kokura Kita-ku, Kitakyushu 802-8555, Japan shoji-matsumoto{at}384.jp

Objective: Cerebral hyperperfusion syndrome (CHS) following carotid artery stenting (CAS) or carotid endarterectomy (CEA) is rare but often fatal once intracranial hemorrhage has occurred. In particular, CHS occurs significantly earlier after CAS than after CEA. Thus a monitoring method for early detection of CHS is required. Near-infrared spectroscopy (NIRS) provides a noninvasive monitoring technique for assessing regional cerebral oxygen saturation (rSO2). This study evaluated the usefulness of transcranial NIRS during CAS for prediction of CHS.

Methods: Periprocedural rSO2 was monitored in 64 cases of CAS (52 men, 12 women; 71 ± 6.6 years). The average degree of carotid stenosis was 76.8 ± 11.3% by North American Symptomatic Carotid Endarterectomy Trial criteria. Bifrontal rSO2 was monitored during the procedure using NIRS. Seventeen patients were symptomatic and 47 were asymptomatic. CHS was diagnosed by increased cerebral blood flow by SPECT performed on the day after treatment with deterioration of neurologic symptoms.

Results: CHS was observed in two cases (3.1%). In the CHS group, post-reperfusion rSO2 values increased >24% from baseline until 3 minutes after reperfusion. In the non-CHS group, the normal upper limit (NUL) of the rSO2 change was set at 10.0% at 3 minutes after reperfusion. In the CHS group, rSO2 at 3 minutes after reperfusion was markedly higher than the NUL. In patients showing an rSO2 at 3 minutes after reperfusion increased by more than 10.0%, CHS following CAS could be predicted.

Conclusion: Periprocedural increases in regional cerebral oxygen saturation measured by near- infrared spectroscopy can be an excellent predictor of cerebral hyperperfusion syndrome after carotid artery stenting.

Abbreviations: ACZ = acetazolamide; AI = asymmetry index; CAS = carotid artery stenting; CBF = cerebral blood flow; CEA = carotid endarterectomy; CHS = cerebral hyperperfusion syndrome; CVR = cerebral vasoreactivity; HMPAO = hexamethylpropyleneamine oxime; ICA = internal carotid artery; MCA = middle cerebral artery; NIRS = near-infrared spectroscopy; NUL = normal upper limit; rSO2 = regional cerebral oxygen saturation.

Disclosure: The authors report no disclosures.

Medications and Devices: Argatroban (Novastan®; Mitsubishi Tanabe Pharma Co. Ltd., Tokyo, Japan); aspirin (BayaspirinTM; Bayer Yakuhin Co. Ltd., Osaka, Japan); cilostazol (Pletal®; Otsuka Pharmaceutical Co. Ltd., Tokushima, Japan); clopidogrel (Plavix®; Sanofi-Aventis Co. Ltd., Tokyo, Japan); heparin (Novo-HeparinTM; Mochida Pharmaceutical Co. Ltd., Tokyo, Japan); Percusurge Guard Wire System (Medtronic AVE, Santa Rosa, CA); Precise (Johnson & Johnson, Miami Lakes, FL); Protege (EV3, Plymouth, MN); Wallstent RP (Boston Scientific, Natick, MA); rotating three-head gamma camera (Prism3000XP, Picker, Cleveland, OH); transcranial cerebral oximeter (INVOS 5100; Somanetics, Troy, MI).

Received September 9, 2008. Accepted in final form February 2, 2009.






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