Evaluation of preoperative cervical internal carotid artery diameter as a predictor of cerebral hyperperfusion syndrome following revascularization surgery

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-08-27 DOI:10.1016/j.clineuro.2025.109125

Mitsuhiro Anan , Kohei Onishi , Masaki Morishige , Kunpei Takao , Wataru Matsushita , Kaito Arimatsu , So Okuma , Yukari Kawasaki , Yasuyuki Nagai , Yu Takeda , Nobuhiro Hata , Minoru Fujiki

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Abstract

Objective

Cerebral hyperperfusion syndrome (CHS) is potentially life-threatening complication after carotid revascularization procedures. This study aims to evaluate whether preoperative cervical internal carotid artery (ICA) diameter can serve as a predictor for CHS following carotid endarterectomy (CEA) or carotid artery stenting (CAS).

Methods

A retrospective cohort of 78 patients undergoing CEA or CAS between 2011 and 2024 was analyzed. ICA diameters were measured preoperatively at three standard cervical segments using contrast-enhanced computed tomography or digital subtraction angiography. The association between diameter measurements and postoperative CHS was statistically evaluated.

Results

CHS occurred in 4 cases (5.1 %). The CHS group had significantly smaller treated-side ICA diameters (median 2.73 mm vs 3.89 mm, p = 0.019), larger contralateral ICA diameters (4.89 mm vs 4.33 mm, p = 0.047), and high stenosis ratio (0.57 vs 0.88, p = 0.0017). A stenosis ratio 0.677 was identified as a significant predictor of CHS (AUC = 0.97, 95 % CI: 0.924–1.000; sensitivity = 100 %, specificity = 92 %).

Conclusion

Preoperative assessment of ICA diameters may help predict the risk of CHS. This anatomical metric should be considered in conjunction with hemodynamic evaluations to enhance perioperative risk stratification.

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评估术前颈内动脉直径对血运重建术后脑高灌注综合征的预测作用

目的颅内高灌注综合征（CHS）是颈动脉血运重建术后可能危及生命的并发症。本研究旨在评估术前颈内动脉（ICA）直径是否可以作为颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS）后CHS的预测指标。方法回顾性分析2011 ~ 2024年间78例经CEA或CAS治疗的患者。术前使用对比增强计算机断层扫描或数字减影血管造影测量三个标准颈椎节段的ICA直径。对直径测量与术后CHS之间的关系进行统计学评价。结果发生4例（5.1% %）。CHS组显著较小treated-side ICA直径(平均2.73 毫米vs 3.89 毫米,p = 0.019),大侧ICA直径(4.89 毫米vs 4.33 毫米,p = 0.047),和高狭窄率(0.57 vs 0.88, p = 0.0017)。狭窄比0.677被确定为CHS的重要预测因子（AUC = 0.97, 95 % CI: 0.924-1.000；敏感性= 100 %，特异性= 92 %）。结论术前评估内窥镜直径有助于预测CHS的发生风险。这种解剖学指标应与血流动力学评估结合考虑，以增强围手术期风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.