Pathophysiology and management of reperfusion injury and hyperperfusion syndrome after carotid endarterectomy and carotid artery stenting

Farooq, Muhammad Umar; Goshgarian, Christopher; Jiao, Min; Gorelick, Philip B.

doi:10.1186/s13231-016-0021-2

Cited by 105 publications

(106 citation statements)

References 37 publications

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“…Moreover, BP control may be challenging, and even when there is normal BP, CHS can occur 9. Abou-Chebl et al 10 strictly maintained BP at <120/80 mm Hg in patients at high risk of CHS and found a significant decrease in the incidence of CHS and ICH.…”

Section: Discussionmentioning

confidence: 99%

Republished: Cortical blindness as a rare presentation of hemorrhagic cerebral hyperperfusion syndrome following vertebral angioplasty

et al. 2018

J NeuroIntervent Surg

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Cerebral hyperperfusion syndrome (CHS) is a well-documented complication after carotid endarterectomy or stenting. In contrast, CHS following vertebral revascularization is extremely rare. Here we present a case of a 77-year-old man with high-grade vertebral stenosis who subsequently underwent balloon angioplasty, complicated by hemorrhagic CHS manifesting as cortical blindness, although strict postoperative blood pressure control was administered. To our knowledge, cortical blindness as a presentation of hemorrhagic CHS has not previously been reported. This study highlights the fact that identifying high-risk patients, as well as making an individual therapeutic plan, is important prior to revascularization. Further studies are needed to elucidate the exact mechanism of this condition and thereby prevent it.

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Section: Discussionmentioning

confidence: 99%

Republished: Cortical blindness as a rare presentation of hemorrhagic cerebral hyperperfusion syndrome following vertebral angioplasty

et al. 2018

J NeuroIntervent Surg

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“…Animal studies show that there might be a role of transforming growth factor beta (TGFβ) signaling pathway. [13][14][15]…”

Section: Chronic Hypertension and Related Vascular Changesmentioning

confidence: 99%

Cerebral Hyperperfusion Syndrome after Carotid Revascularization: A Brief Review

Anand

Sahoo

2019

Journal of Neuroanaesthesiology and Critical Care

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Cerebral hyperperfusion (CHS) syndrome is a relatively rare but potentially devastating event that can complicate carotid endarterectomy and carotid stenting. It is associated with increased cerebral perfusion usually more than 100% from the baseline along with ipsilateral headache, seizures, focal neurological deficits, encephalopathy, intracranial hemorrhage, or subarachnoid hemorrhage. Various risk factors have been identified but most important risk factor is preprocedure evidence of reduced cerebral vasoreactivity with or without contralateral severe carotid stenosis or occlusion. Although diagnosis is suspected in patients with clinical suspicion, it can be radiologically demonstrated with computed tomography (CT), magnetic resonance imaging (MRI), and by dynamic imaging of cerebral perfusion such as transcranial Doppler (TCD), CT, and MR perfusion, and single-photon emission computed tomography (SPECT). Management is usually centered around prompt recognition and active regulation of blood pressure in perioperative and postoperative periods to limit the rise of cerebral blood flow. Prognosis depends on the early detection and prompt management of CHS. If detected early, coupled with intensive blood pressure management, almost all patients will recover over a period of time. For those patients who are diagnosed late and those progressing to intracranial hemorrhage (ICH), the prognosis is not nearly as good.

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“…Clinical presentation includes acute neurological deficits such as new onset headache, seizures, hemiparesis or intracerebral haemorrhage. Early detection of the CHS is paramount to administer an appropriate management and decrease the likelihood of cerebral injury 2. CT perfusion has been proposed as a predictive tool for CHS in patients receiving intervention for carotid stenosis,3 and it is suitable to provide evidence of hyperperfusion and guide medical treatment.…”

Section: Descriptionmentioning

confidence: 99%

Cerebral hyperperfusion syndrome after spontaneous recanalisation of carotid in-stent thrombosis

et al. 2017

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DescriptionA 68-year-old man with medical history significant for hypertension and stroke was transferred to our hospital with new onset dysarthria, right face and arm weakness following left carotid stent deployed 24 hours before. The National Institutes of Health Stroke Scale at admission was 7. Head and neck CT angiographies (CTAs) were performed demonstrating in-stent thrombosis of the left carotid artery ( figure 1A) and a CT perfusion showed no core infarct but a perfusion defect within the left middle cerebral artery (MCA) territory, as defined by a Tmax greater than 6 s, measuring 78.9 mL (figure 1B).Decision was made to treat him conservatively by starting heparin gtt and blood pressure augmentation with norepinephrine for systolic blood pressure goal >160 mm Hg. Forty-eight hours after admission, the patient complained of severe headache associated with right-sided paraesthesias and right-sided motor focal seizure without impaired consciousness in the setting of blood pressure nearing 200 mm Hg. An emergent CT head was performed to rule out haemorrhage. The CTA demonstrated recanalisation of the left carotid artery ( figure 2A) and a CT perfusion showed hyperperfusion in the left cerebrum, as defined by increased relative cerebral blood flow (CBF) and relative cerebral blood volume (CBV) along with decreased mean transit time (MTT) and reduced Tmax (figure 2B). Blood pressure was controlled to less than 130 mm Hg, protamine was given to reverse heparin and the patient was loaded on levetiracetam as a seizure prophylaxis measure. Sudden recanalisation of the carotid artery resulted in an increased and unregulated CBF leading to a cerebral hyperperfusion syndrome (CHS). Subsequent MRI demonstrated the old infarct lesion and new lacunar infarcts in the distribution of the left MCA (figure 3). The patient was stabilised and discharged to a rehabilitation facility. At 90-day clinical follow-up, the patient has a modified Rankin Scale of 4 and he is being taken care at a nursing home.The CHS is a rare condition that can result after carotid endarterectomy or carotid artery stenting.

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Pathophysiology and management of reperfusion injury and hyperperfusion syndrome after carotid endarterectomy and carotid artery stenting

Cited by 105 publications

References 37 publications

Republished: Cortical blindness as a rare presentation of hemorrhagic cerebral hyperperfusion syndrome following vertebral angioplasty

Republished: Cortical blindness as a rare presentation of hemorrhagic cerebral hyperperfusion syndrome following vertebral angioplasty

Cerebral Hyperperfusion Syndrome after Carotid Revascularization: A Brief Review

Cerebral hyperperfusion syndrome after spontaneous recanalisation of carotid in-stent thrombosis

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