Analysis Of Risk Factors For Hyperperfusion State Following Carotid Artery Stenting

Objective: Highperfusion state(HS)is closely associated with cerebral hyperperfusion syndrome(CHS).Therefore,early diagnosis and effective intervention of HS patients who underwent carotid artery stenting(CAS)are powerful tools for reducing CHS incidence.This research seeks to explore the preoperative related risk factors of HS following CAS.Methods: The clinical data of these patients who were diagnosed as carotid stenosis and underwent CAS in the First Affiliated Hospital of Wannan Medical College from September 2018 to December 2019 were analyzed.Transcranial Doppler(TCD)was applied to monitoring the mean blood flow velocity of the middle cerebral artery(MCAVmean)in all patients before and 24 hours after operation in the perioperative period.The patients were divided into the HS group and the non-HS group according to the MCAVmean parameter.HS group was defined as patients with postoperative MCAVmean≥100% compared with preoperative baseline level,while non-HS group was defined as patients with postoperative MCAVmean<100% compared with preoperative level.The clinical data and blood flow velocity parameters of all participants were analyzed to further investigate the risk factors correlated with HS.Results: A total of 103 CAS patients who underwent carotid artery stenting,aged from 44-83 years,including 79(76.7%)males,were enrolled in this study.2 of 14 patients(11 males)complicated with CHS after the operation in HS group.However,in the non-HS group of 89 patients(68 males),no patient occurred complication of CHS.Univariate analysis showed that there were more diabetic patients,more severe carotid artery stenosis degree and lower preoperative MCAVmean value in HS group than the non-HS group(all P<0.05).The Logistic regression analysis revealed that the diabetes mellitus(OR=4.727;95%CI: 1.003-21.631;P<0.05)and preoperative ipsilateral MCAVMean(OR=0.896;95%CI: 0.842-0.955;P<0.05)were significantly related with the occurrence of HS after CAS.Furthermore,the ROC curve was applied to establishing a prediction model for the occurrence of HS after CAS.The area under the ROC curve was 0.874(P<0.001,95%CI: 0.797-0.950),the optimal cut-off value was 40.1cm/s,the sensitivity was 0.929,and the specificity was 0.742.Conclusion: The results of this study showed that preoperative diabetes and the MCAVmean≤40.1cm/s on the surgical side monitored by TCD were risk factors for HS.These indicators need to be monitored before CAS,and further large-scale studies are required to confirm these results.