Acetazolamide-Challenged Brain CT Perfusion before and after Carotid Stenting

ipsilateral cerebral blood flow (CBF) above the metabolic demands of the brain tissue following repair of unilateral carotid stenosis (1). The patient with hyperperfusion may rarely develop the hyperperfusion syndrome, including severe ipsilateral headache, face and eye pain, seizures, and intracerebral hemorrhage (1-3), which is a rare but devastating complication after carotid endarterectomy (CEA) or carotid stenting (CS) (2, 4). It is difficult to control and treat when hyperperfusion syndrome occurs (5, 6). Hyperperfusion syndrome related to intracerebral hemorrhage rarely occurs with the incidence of 0.4% to 2.1% (7-10). However, the risk of intracerebral hemorrhage in patients with hyperperfusion was known to be ten times higher than that of patients without hyperperfusion, and the prognosis for patient with intracerebral hemorrhage is very poor, with high mortality rates (1).