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http://dx.doi.org/10.3340/jkns.2013.54.3.159

Post-Carotid Endarterectomy Cerebral Hyperperfusion Syndrome : Is It Preventable by Strict Blood Pressure Control?  

Kim, Kyung Hyun (Department of Neurosurgery, Seoul National University Hospital)
Lee, Chang-Hyun (Department of Neurosurgery, Seoul National University Bundang Hospital)
Son, Young-Je (Department of Neurosurgery, SMG-SNU Boramae Medical Center)
Yang, Hee-Jin (Department of Neurosurgery, SMG-SNU Boramae Medical Center)
Chung, Young Sub (Department of Neurosurgery, SMG-SNU Boramae Medical Center)
Lee, Sang Hyung (Department of Neurosurgery, SMG-SNU Boramae Medical Center)
Publication Information
Journal of Korean Neurosurgical Society / v.54, no.3, 2013 , pp. 159-163 More about this Journal
Abstract
Objective : Cerebral hyperperfusion syndrome (CHS) is a serious complication after carotid endarterectomy (CEA). However, the prevalence of CHS has decreased as techniques have improved. This study evaluates the role of strict blood pressure (BP) control for the prevention of CHS. Methods : All 18 patients who received CEA from February 2009 through November 2012 were retrospectively reviewed. All patients were routinely managed in an intensive care unit by a same protocol. The cerebral perfusion state was evaluated on the basis of the regional cerebral blood flow (rCBF) study by perfusion computed tomography (pCT) and mean velocity by transcranial doppler (TCD). BP was strictly controlled (<140/90 mm Hg) for 7 days. When either post-CEA hyperperfusion (>100% increase in the rCBF by pCT or in the mean velocity by TCD compared with preoperative values) or CHS was detected, BP was maintained below 120/80 mm Hg. Results : TCD and pCT data on the patients were analyzed. Ipsilateral rCBF was significantly increased after CEA in the pCT (p=0.049). Post-CEA hyperperfusion was observed in 3 patients (18.7%) in the pCT and 2 patients (12.5%) in the TCD study. No patients developed clinical CHS for one month after CEA. Furthermore, no patients developed additional neurological deficits related to postoperative cerebrovascular complications. Conclusion : Intensive care with strict BP control (<140/90 mm Hg) achieved a low prevalence of post-CEA hyperperfusion and prevented CHS. This study suggests that intensive care with strict BP control can prevent the prevalence of post-CEA CHS.
Keywords
Carotid endarterectomy; Hyperperfusion; Cerebral blood flow; Blood pressure; Cerebral hyperperfusion syndrome;
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1 Holm J, Nilsson U, Waters N, Waters S, Jonsson O : Production of free radicals measured by spin trapping during operations for stenosis of the carotid artery. Eur J Surg 167 : 4-9, 2001   DOI
2 Hosoda K, Kawaguchi T, Shibata Y, Kamei M, Kidoguchi K, Koyama J, et al. : Cerebral vasoreactivity and internal carotid artery flow help to identify patients at risk for hyperperfusion after carotid endarterectomy. Stroke 32 : 1567-1573, 2001   DOI
3 Komoribayashi N, Ogasawara K, Kobayashi M, Saitoh H, Terasaki K, Inoue T, et al. : Cerebral hyperperfusion after carotid endarterectomy is associated with preoperative hemodynamic impairment and intraoperative cerebral ischemia. J Cereb Blood Flow Metab 26 : 878-884, 2006   DOI
4 Jørgensen LG, Schroeder TV : Defective cerebrovascular autoregulation after carotid endarterectomy. Eur J Vasc Surg 7 : 370-379, 1993   DOI
5 Kawamata T, Okada Y, Kawashima A, Yoneyama T, Yamaguchi K, Ono Y, et al. : Postcarotid endarterectomy cerebral hyperperfusion can be prevented by minimizing intraoperative cerebral ischemia and strict postoperative blood pressure control under continuous sedation. Neurosurgery 64 : 447-453; discussion 453-454, 2009   DOI
6 Kim DE, Choi SM, Yoon W, Kim BC : Hyperperfusion syndrome after carotid stent-supported angioplasty in patients with autonomic dysfunction. J Korean Neurosurg Soc 52 : 476-479, 2012   DOI
7 Lagreze HL, Levine RL, Sunderland JS, Nickles RJ : Pitfalls of regional cerebral blood flow analysis in cerebrovascular disease. Clin Nucl Med 13 : 197-201, 1988   DOI
8 Lee CH, Jung YS, Yang HJ, Son YJ, Lee SH : An innovative method for detecting surgical errors using indocyanine green angiography during carotid endarterectomy : a preliminary investigation. Acta Neurochir (Wien) 154 : 67-73; discussion 73, 2012   DOI
9 Maas MB, Kwolek CJ, Hirsch JA, Jaff MR, Rordorf GA : Clinical risk predictors for cerebral hyperperfusion syndrome after carotid endarterectomy. J Neurol Neurosurg Psychiatry 84 : 569-572, 2013   DOI
10 Abou-Chebl A, Reginelli J, Bajzer CT, Yadav JS : Intensive treatment of hypertension decreases the risk of hyperperfusion and intracerebral hemorrhage following carotid artery stenting. Catheter Cardiovasc Interv 69 : 690-696, 2007   DOI
11 Adhiyaman V, Alexander S : Cerebral hyperperfusion syndrome following carotid endarterectomy. QJM 100 : 239-244, 2007   DOI
12 Coutts SB, Hill MD, Hu WY : Hyperperfusion syndrome : toward a stricter definition. Neurosurgery 53 : 1053-1058; discussion 1058-1060, 2003   DOI
13 Bernstein M, Fleming JF, Deck JH : Cerebral hyperperfusion after carotid endarterectomy : a cause of cerebral hemorrhage. Neurosurgery 15 : 50-56, 1984   DOI
14 Biller J, Feinberg WM, Castaldo JE, Whittemore AD, Harbaugh RE, Dempsey RJ, et al. : Guidelines for carotid endarterectomy : a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 29 : 554-562, 1998   DOI
15 Bouri S, Thapar A, Shalhoub J, Jayasooriya G, Fernando A, Franklin IJ, et al. : Hypertension and the post-carotid endarterectomy cerebral hyperperfusion syndrome. Eur J Vasc Endovasc Surg 41 : 229-237, 2011   DOI
16 De Rango P : Cerebral hyperperfusion syndrome : the dark side of carotid endarterectomy. Eur J Vasc Endovasc Surg 43 : 377, 2012   DOI
17 Greenberg MS : Handbook of Neurosurgery, ed 7. Florida : Thieme, 2010, pp1152
18 Henderson RD, Phan TG, Piepgras DG, Wijdicks EF : Mechanisms of intracerebral hemorrhage after carotid endarterectomy. J Neurosurg 95 : 964-969, 2001   DOI
19 Meyers PM, Higashida RT, Phatouros CC, Malek AM, Lempert TE, Dowd CF, et al. : Cerebral hyperperfusion syndrome after percutaneous transluminal stenting of the craniocervical arteries. Neurosurgery 47 : 335-343; discussion 343-345, 2000   DOI
20 Naylor AR, Evans J, Thompson MM, London NJ, Abbott RJ, Cherryman G, et al. : Seizures after carotid endarterectomy : hyperperfusion, dysautoregulation or hypertensive encephalopathy? Eur J Vasc Endovasc Surg 26 : 39-44, 2003   DOI
21 Miyamoto N, Naito I, Takatama S, Shimizu T, Iwai T, Shimaguchi H : Urgent stenting for patients with acute stroke due to atherosclerotic occlusive lesions of the cervical internal carotid artery. Neurol Med Chir (Tokyo) 48 : 49-55; discussion 55-56, 2008   DOI
22 Morrish W, Grahovac S, Douen A, Cheung G, Hu W, Farb R, et al. : Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis. AJNR Am J Neuroradiol 21 : 1911-1916, 2000
23 Ogasawara K, Sakai N, Kuroiwa T, Hosoda K, Iihara K, Toyoda K, et al. : Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting : retrospective review of 4494 patients. J Neurosurg 107 : 1130-1136, 2007   DOI
24 Ogasawara K, Yukawa H, Kobayashi M, Mikami C, Konno H, Terasaki K, et al. : Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning. J Neurosurg 99 : 504-510, 2003   DOI
25 Pennekamp CW, Tromp SC, Ackerstaff RG, Bots ML, Immink RV, Spiering W, et al. : Prediction of cerebral hyperperfusion after carotid endarterectomy with transcranial Doppler. Eur J Vasc Endovasc Surg 43 : 371-376, 2012   DOI
26 Schroeder T, Sillesen H, Sørensen O, Engell HC : Cerebral hyperperfusion following carotid endarterectomy. J Neurosurg 66 : 824-829, 1987   DOI
27 Reigel MM, Hollier LH, Sundt TM Jr, Piepgras DG, Sharbrough FW, Cherry KJ : Cerebral hyperperfusion syndrome : a cause of neurologic dysfunction after carotid endarterectomy. J Vasc Surg 5 : 628-634, 1987   DOI
28 Solomon RA, Loftus CM, Quest DO, Correll JW : Incidence and etiology of intracerebral hemorrhage following carotid endarterectomy. J Neurosurg 64 : 29-34, 1986   DOI
29 Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK; Society for Vascular Surgery : Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg 54 : e1-e31, 2011   DOI
30 Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK; Society for Vascular Surgery : Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease : executive summary. J Vasc Surg 54 : 832-836, 2011   DOI
31 Soong CV, Young IS, Hood JM, Rowlands BJ, Trimble ER, Barros D'Sa AA : The generation of byproducts of lipid peroxidation following carotid endarterectomy. Eur J Vasc Endovasc Surg 12 : 455-458, 1996   DOI
32 Sundt TM Jr, Sharbrough FW, Piepgras DG, Kearns TP, Messick JM Jr, O'Fallon WM : Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy : with results of surgery and hemodynamics of cerebral ischemia. Mayo Clin Proc 56 : 533-543, 1981
33 Terada T, Tsuura M, Matsumoto H, Masuo O, Tsumoto T, Yamaga H, et al. : Hemorrhagic complications after endovascular therapy for atherosclerotic intracranial arterial stenoses. Neurosurgery 59 : 310-318; discussion 310-318, 2006   DOI
34 van Mook WN, Rennenberg RJ, Schurink GW, van Oostenbrugge RJ, Mess WH, Hofman PA, et al. : Cerebral hyperperfusion syndrome. Lancet Neurol 4 : 877-888, 2005   DOI