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To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2009.00361.x Byline: Marcel Brus-Ramer (1), Robert M. Starke (1), Ricardo J. Komotar (1), Philip M. Meyers (1) Keywords: Hyperperfusion; stenting; stenosis; intracranial; arteriosclerosis Abstract: ABSTRACT 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. Author Affiliation: (1)From the Department of Neuroscience (MBR); and Department of Neurological Surgery, Columbia University, New York, NY (RMS, RJK, PMM). Article History: Acceptance: Received July 6, 2008, and in revised form November 26, 2008. Accepted for publication December 15, 2008. Article note: Correspondence: Adderss correspondence to Philip M. Meyers, MD, Department of Neurosurgery, Columbia University, 710 West 168th Street, Rm 428, Neurological Institute, New York NY 10032. E-mail: pmm2002@columbia.edu

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2008.00313.x Byline: Rishi Gupta (1), Archit Bhatt (1), Mounzer Kassab (1), Arshad Majid (1) Keywords: Re-stenosis; stents; C-reactive protein Abstract: ABSTRACT BACKGROUND AND PURPOSE High-sensitivity C-reactive protein (hsCRP) is an inflammatory marker associated with subsequent coronary events and neointimal hyperplasia after coronary artery stent placement. We sought to determine if elevated levels of hsCRP are associated with restenosis after placement of extra- and intracranial stents. METHODS We retrospectively reviewed 73 consecutive patients at Michigan State University from July 2006 until June 2007 who underwent treatment with carotid artery stent placement or intracranial stent placement. Data were collected in regards to demographics, pre-procedural hsCRP, and LDL levels, and angiographic variables characterizing the lesion before and after treatment. A binary logistic regression model was constructed to determine independent predictors of restenosis. RESULTS A total of 73 patients with a mean age of 69 [+ or -] 11 years were studied. A total of 57 patients were treated with extracranial carotid stenting, 22 (38%) of whom were symptomatic, while 16 patients underwent intracranial stenting (all were symptomatic). There were 9 patients (4 intracranial stents [25%] and 5 carotid stents [8.8%]) who developed a restenosis of >50%. In binary logistic regression modeling, the following variables were found to be independently predictive of developing restenosis: smaller vessel diameter (OR .49, 95% CI .23-.98, P-value .046) and elevated hsCRP (OR 2.2, 95% CI 1.29-6.66, P-value .018). CONCLUSIONS Elevated levels of pre-procedural hsCRP may be predictive of the development of neointimal hyperplasia in patients treated with extra- or intracranial stenting procedures. Future prospective multicenter studies will be required to confirm these findings. J Neuroimaging 2010;20:74-77. Author Affiliation: (1)From the Department of Neurology, Division of Cerebrovascular Diseases, Michigan State University/Sparrow Health System, East Lansing, MI (RG, AB, MK, AM); and Cerebrovascular Center, the Cleveland Clinic Foundation, Cleveland, OH (RG). Article History: Acceptance: Received January 5, 2008, and in revised form February 11, 2008. Accepted for publication February 27, 2008. Article note: Correspondence: Address correspondence to Rishi Gupta, MD, Cerebrovascular Center, the Cleveland Clinic Foundation, 9500 Euclid Avenue, S80, Cleveland, OH 44195. E-mail: guptar@ccf.org.

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1552-6569.2008.00269.x Byline: Italo Linfante (1), Vincenzo Andreone (1), Nabil Akkawi (1), Ajay K. Wakhloo (1) Keywords: Stenting; angioplasty; elderly; stroke; prevention; carotid stenosis Abstract: ABSTRACT BACKGROUND Thirty percent to 40% of strokes in the elderly are secondary to carotid bifurcation disease. The treatment of internal carotid artery (ICA) stenosis in this patient population is a clinical dilemma. Age more than 80 years is a risk factor for carotid endarterectomy (CEA). Carotid artery stenting (CAS) may be also associated with increased peri-procedural complications in this age group. DESIGN This study was a single-center, retrospective database analysis evaluating CAS in patients more than 80 years old. Primary outcome included death, myocardial infarction (MI), or ipsilateral stroke. Secondary outcome included re-stenosis at 30 days, 6 months, and 1-year post-procedure. RESULTS Between March 2001 and March 2004, CAS was performed in 178 patients. Twenty-four patients were more than 80 years old (range 80-91), and 16 men, 70.8%, were symptomatic. Success rate was 100% with residual stenosis of CONCLUSIONS CAS can be performed in patients more than 80 years old. Complications may be higher than in younger patients. However, because of the high prevalence of stroke in octogenarians, randomized trials should include this patient population. Author Affiliation: (1) Section of Endovascular Neurosurgery, Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, 8900 North Kendal Drive, Miami, FL 33176 Article History: Acceptance: Received March 2, 2008, and in revised form March 2, 2008. Accepted for publication March 25, 2008. Article note: Correspondence: Address correspondence to Italo Linfante, MD, Endovascular Neurosurgery, Interventional Neuroradiology, Baptist Cardiac and Vascular Institute, 8900 North Kendal Drive, Miami, FL 33176. E-mail: italol@baptisthealth.net.