Intracranial hemorrhage and hyperperfusion syndrome following carotid artery stenting

Abstract

The hyperperfusion syndrome occurs infrequently following CAS, and ICH occurs in 0.67% of patients. Patients with severe bilateral carotid stenoses may be predisposed to ICH, particularly if there is concurrent arterial hypertension. Patients with these factors may require more intensive hemodynamic monitoring after CAS, including prolongation of hospitalization in some cases.

Atherosclerotic Carotid Stenoses of Apical versus Body Lesions in High-Risk Carotid Stenting Patients

“…31,32 The distance between the carotid bifurcation and the maximum stenotic lesion (Յ10 mm) was reported to be an independent risk factor for carotid artery stent placement in 31 patients, as lesions with maximum stenosis Ͼ10 mm from the carotid bifurcation were associated with a low incidence of hypotension. 33 Hyperperfusion syndrome 34 occurred frequently in our patients with body-type lesions, suggesting that the carotid body has a hemodynamic effect on the ipsilateral cerebral circulation.…”

Simultaneous Bilateral Carotid Stenting in High-Risk Patients

“…Therefore, our data suggested that careful management of BP is required for almost 1 month after BSCAS to avoid HPS, though the incidence was relatively low. 1,21,32 Although staged CAS, because it may decrease the occurrence of HPS and HD, is more acceptable and therefore more frequently performed, there are obvious disadvantages to a staged intervention, including the higher medical cost and inconvenience to the patient. It may also potentially cause the delay of life-saving treatment such as open-heart surgery or even cause another cerebral infarction.…”

“…HPS was diagnosed as the occurrence of ipsilateral (to the treated artery) throbbing headache with or without nausea, vomiting, or ipsilateral focal seizures, or the presence a focal neurologic deficit without radiographic evidence of infarction. 21 Perfusion-weighted MR images, CT perfusion, or single-photon emission tomography was performed for these patients with suspected HPS following the procedure. Any symptomatic or asymptomatic hypotension (systolic BP Ͻ90 mm Hg or bradycardia, ie, heart rate …”

Intraprocedural Changes in Angiographic Cerebral Circulation Time Predict Cerebral Blood Flow After Carotid Artery Stenting

“…15,25) Both CEA 8,11,13,25,28) and CAS can improve CBF impairment. 12,18,29) However, hyperperfusion syndrome (HPS) has been reported after both procedures, 1,2,10,16,17,22,23) so prevention and treatment of HPS are important issues in the perioperative management of patients undergoing CAS. Postprocedural HPS is most common in patients with CBF increases of more than 100% compared with the preoperative value, and rare in patients with CBF gains of less than 100% of the baseline value.…”

“…However, marked hemodynamic changes in the cerebral circulation associated with the reconstruction of the blood flow in the carotid artery may occur and may require intensive post-procedure management after CAS, 1,2,10,12,16,18,29) as seen in patients treated by CEA. 8,11,13,25,28) Therefore, mild hypertension to keep sufficient cerebral perfusion pressure is recommended in postoperative care for patients with preceding impaired cerebral circulation if adequate improvement in cerebral blood flow (CBF) is not observed after carotid revascularization.…”