Preoperative risk factors and preventive control measures for cerebral hypoperfusion syndrome after carotid artery stenting in patients with carotid stenosis

XIE Jing; JIANG Haiying; MIAO Suyu

doi:10.3969/j.issn.1002-7386.2026.02.020

Abstract：Objective To analyze the main preoperative risk factors for cerebral hypoperfusion syndrome(CHS)after carotid artery stenting(CAS)in patients with carotid stenosis via a retrospective analysis,thus providing references for formulating prevention and treatment measures of CHS.Methods A total of 210 patients with carotid artery stenosis who underwent CAS treatment in our hospital from October 2022 to October 2023 were selected.They were divided into the CHS group and the non-CHS group based on whether postoperative CHS occurred.General information,past disease history,collateral circulation compensation,preoperative vascular stenosis rate,preoperative cerebral blood flow asymmetry index(AI),preoperative mean blood flow velocity in the middle cerebral artery(MCAVmean)and surgical time window(onset to treatment time)were collected.Baseline characteristics were analyzed via univariate and multivariate logistic regression and compared between groups.The receiver operating characteristic(ROC)curve was plotted to analyze the predictive efficacy of independent risk factors for postoperative CHS in patients with carotid stenosis.Results Among 210 patients with carotid stenosis treated with CAS,12 cases experienced postoperative CHS(CHS group)and 198 patients did not experience CHS(non CHS group),showing an incidence of postoperative CHS of 5.71%(12/210).Significant differences in history of diabetes,new cerebral infarction within 1 month,collateral circulation compensation,preoperative vascular stenosis rate,AI,preoperative MCAVmean and operation time window were found between groups(P<0.05).Logistic regression analysis showed that diabetes,new cerebral infarction within 1 month,poor collateral circulation compensation,low AI and slow preoperative MCAVmean were independent risk factors for postoperative CHS in patients with carotid stenosis after CAS treatment(P<0.05).The ROC curve showed that the predicted AUC of diabetes,new cerebral infarction within 1 month,collateral circulation compensation,AI and preoperative MCAVmean for postoperative CHS in patients with carotid stenosis after CAS treatment was 0.677,0.638,0.756,0.734 and 0.743,respectively,with a sensitivity of 60.00%,57.50%,78.50%,70.00%and 72.50%,and a specificity of 50.00%,62.50%,71.50%,71.50%,71.50%and 82.50%,respectively.Conclusion Previous complications of diabetes,new cerebral infarction within 1 month,poor collateral circulation compensation,low AI and slow MCAVmean are the main preoperative risk factors for postoperative CHS in patients with carotid stenosis treated with CAS,all of which have certain predictive effect.Clinical attention should be focused on whether patients contain the above risk factors,and preventive control measures should be taken as early as possible to reduce the incidence of CHS.