Change in Cerebral Blood Flow after Palliative Percutaneous Angioplasty and Timing of Second Stage Carotid Artery Stenting in Staged Angioplasty

The purpose of this study is to elucidate the hemodynamic changes after palliative angioplasty and the timing of second stage carotid artery stenting (CAS) in staged angioplasty for patients with severe hemodynamically compromised carotid artery stenosis. Among consecutive 111 patients with carotid artery stenosis, chronological changes in the cerebral blood flow of all 11 hemodynamically compromised patients treated with CAS were evaluated with single photon emission computed tomogram (SPECT) in each stage of the treatment. Ten of these 11 patients underwent staged angioplasty and one was treated with single-stage CAS. All the 10 patients who underwent staged angioplasty showed improved cerebral vascular reactivity (CVR) on SPECT after the first stage palliative angioplasty. Only one patient treated with staged angioplasty with 4-week interval before the CAS showed restenosis of the lesion. Cerebral hyperperfusion syndrome (CHS) was not observed in nine of 10 patients with staged angioplasty. One patient of staged angioplasty (who presented restenosis at the time of elective CAS) and another patient in whom we could not apply staged angioplasty (for his renal dysfunction) showed CHS after CAS. In conclusion, restoration of CVR could be achieved within a few days following palliative angioplasty, and 1–2-week interval is enough for staged angioplasty.