Safety and efficacy of staged angioplasty for patients at risk of hyperperfusion syndrome: a single-center retrospective study

Satoshi Murai, Kenji Sugiu, Tomohito Hishikawa, Masafumi Hiramatsu, Shingo Nishihiro, Naoya Kidani, Yu Takahashi, Kazuhiko Nishi, Yoko Yamaoka, Isao Date

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Purpose: Intracranial hemorrhage following hyperperfusion syndrome (HPS) is a rare but potentially fatal complication after carotid artery stenting (CAS). Staged angioplasty (SAP) is a two-stage form of CAS that can prevent the abrupt increase of cerebral blood flow. In this study, we investigated the safety and efficacy of SAP. Methods: One hundred thirty-four patients who underwent CAS for high-grade carotid artery stenosis between January 2010 and December 2018 were enrolled. Patients who showed severe impairment of hemodynamic reserve in 123I-IMP SPECT with acetazolamide received SAP (SAP group), while the others received regular CAS (RS group). Results: Twenty-six (19.4%) patients at risk for HPS received SAP. HPS was not observed in either group. Diffusion-weighted image (DWI)-positive lesions on postoperative MRI were observed in 56 (52.3%) cases in the RS group and 16 (64.0%) cases in the SAP group. Symptomatic procedure-related complications occurred in 5 (4.6%) cases in the RS group and 1 (3.8%) case in the SAP group. These differences were not statistically significant. Modified Rankin Scale score had declined 30 days after discharge in 4 (3.0%) cases. Distal filter protection was significantly correlated to the occurrence of new DWI-positive lesions. Conclusions: For patients at high risk of HPS, SAP was a reasonable treatment strategy to prevent HPS. SAP did not increase the rate of DWI-positive lesions or procedure-related complications compared with regular CAS.

Original languageEnglish
Pages (from-to)503-510
Number of pages8
Issue number4
Publication statusPublished - Apr 1 2020


  • Carotid artery stenting
  • Hyperperfusion syndrome
  • Staged angioplasty

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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