Radiographic evidence of cerebral hyperperfusion and reversal following angioplasty and stenting of intracranial carotid and middle cerebral artery stenosis: Case report and review of the literature

BACKGROUND AND PURPOSE Hyperperfusion is a rare but serious complication following cerebrovascular angioplasty and stent placement. Radiographically identifying hyperperfusion before the development of severe sequelae is difficult, as few diagnostic criteria have been established. METHODS A 50-year-old woman, initially presenting with 6 weeks of right-sided hemiparesis and dysarthria, was treated for severe stenosis of the left internal carotid and middle cerebral arteries with intracranial angioplasty and placement of a balloon mounted Wingspan Stent (Boston Scientific, Fremont, CA). Continuous transcranial Doppler monitoring after stent placement indicated developing cerebral hyperperfusion. Concurrent angiography revealed markings consistent with dilatations of small arteries in the vascular territory of the stented arteries. Aggressive blood pressure management started in the procedure and continued postprocedure led to an approximately 40% reduction in systolic blood pressure. RESULTS The patient had an uneventful postoperative course and was discharged without development of neurological sequelae. Long-term (8 months) follow-up found that hemodynamic parameters in the stented left middle cerebral artery only slightly elevated compared to the unaffected right middle cerebral artery. CONCLUSION The high-resolution angiographic image described here may provide a radiologic indication of the onset or progression of cerebral hyperperfusion, permitting appropriate therapeutic management prior to serious sequelae developing.