World neurosurgery · 2026
Prognostic Value of T2-FLAIR Hyperintense Vessel Sign for Cerebral Hyperperfusion Syndrome and Feasibility of Risk-Stratified Perioperative Management Following Carotid Artery Stenting.
СтатьяНазвание и аннотация: Перевод в очереди
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Wan Dongdong, Wang Chao, Liu Hua, Yan Liting, Wu Tao, Yu Jun, Li Yang, Zhang Jianjin
Аннотация
OBJECTIVE: This study aimed to assess the prognostic performance of preoperative T2-FLAIR hyperintense vessel sign (HVS) grading for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS), and to evaluate the clinical feasibility and safety of an HVS-guided risk-stratified perioperative management strategy.
METHODS: A single-center prospective cohort study was conducted on 128 consecutive patients with symptomatic carotid stenosis ≥70 who underwent elective CAS. All participants were categorized into 3 groups based on preoperative HVS grades: low-risk (HVS 0-1), intermediate-risk (HVS 2), and high-risk (HVS 3). Tailored interventions, including session-based staged angioplasty and tiered systolic blood pressure control, were implemented across all groups. The primary clinical endpoint was 30-day symptomatic CHS. Firth penalized logistic regression was applied for exploratory analysis of factors associated with CHS occurrence.
RESULTS: The overall 30-day incidence of symptomatic CHS was 6.3%, with a stepwise rising risk across low-risk (0%), intermediate-risk (5.3%), and high-risk (24%) HVS subgroups (P < 0.001). Exploratory regression analysis revealed that HVS grade ≥2 (OR=6.87, 95% CI: 2.91-16.23, P < 0.001) and incomplete circle of Willis (OR=3.72, 95% CI: 1.58-8.76, P = 0.003) were correlated with higher CHS odds. There were no intergroup differences in total procedural complications, and the CHS incidence of our cohort was numerically lower than that of a historical control group.
CONCLUSIONS: Preoperative T2-FLAIR HVS grading serves as a reliable prognostic marker for stratifying CHS risk in patients receiving CAS. The HVS-guided risk-stratified perioperative management protocol is clinically feasible and safe. As a widely accessible imaging indicator, HVS has promising application value in routine clinical practice. Further large-scale multicenter studies are warranted to validate our findings.
METHODS: A single-center prospective cohort study was conducted on 128 consecutive patients with symptomatic carotid stenosis ≥70 who underwent elective CAS. All participants were categorized into 3 groups based on preoperative HVS grades: low-risk (HVS 0-1), intermediate-risk (HVS 2), and high-risk (HVS 3). Tailored interventions, including session-based staged angioplasty and tiered systolic blood pressure control, were implemented across all groups. The primary clinical endpoint was 30-day symptomatic CHS. Firth penalized logistic regression was applied for exploratory analysis of factors associated with CHS occurrence.
RESULTS: The overall 30-day incidence of symptomatic CHS was 6.3%, with a stepwise rising risk across low-risk (0%), intermediate-risk (5.3%), and high-risk (24%) HVS subgroups (P < 0.001). Exploratory regression analysis revealed that HVS grade ≥2 (OR=6.87, 95% CI: 2.91-16.23, P < 0.001) and incomplete circle of Willis (OR=3.72, 95% CI: 1.58-8.76, P = 0.003) were correlated with higher CHS odds. There were no intergroup differences in total procedural complications, and the CHS incidence of our cohort was numerically lower than that of a historical control group.
CONCLUSIONS: Preoperative T2-FLAIR HVS grading serves as a reliable prognostic marker for stratifying CHS risk in patients receiving CAS. The HVS-guided risk-stratified perioperative management protocol is clinically feasible and safe. As a widely accessible imaging indicator, HVS has promising application value in routine clinical practice. Further large-scale multicenter studies are warranted to validate our findings.