Impact of perioperative cerebral blood flow evaluation using arterial spin labeling in a patient undergoing carotid artery stenting

Background: Hyperperfusion syndrome (HPS) is one of the most serious complications after carotid artery stenting (CAS). Arterial spin labeling (ASL) is a noninvasive method for assessing cerebral perfusion. This study aimed to evaluate the utility of ASL compared to that of SPECT in evaluating changes in intracranial blood flow during the perioperative period of CAS.

Methods: We retrospectively reviewed prospectively collected data from 49 cases of CAS conducted for symptomatic and asymptomatic carotid artery stenosis. We calculated the relative cerebral blood flow (rCBF) from ASL (post labeling delay [PLD] of 1500 ms and 2500 ms) and SPECT, both pre- and post-CAS. Cerebrovascular reactivity (CVR) was assessed using SPECT with an acetazolamide challenge. We defined the change rate from PLD 1500 ms to 2500 ms before CAS as ΔrASL.

Results: Hyperperfusion phenomenon was observed in four cases (8.2 %), with one case (2.0 %) resulting in cerebral hemorrhage and diagnosed as HPS. Positive correlations were noted between ASL and SPECT at both pre- and post-CAS (r = 0.42-0.65, p < 0.01). A negative correlation was found between ΔrASL obtained from the two PLDs before CAS and CVR (r=-0.41, p < 0.01).

Conclusions: ASL using two PLDs is a useful method for evaluating changes in CBF during the perioperative period of CAS.