Cerebral Hyperperfusion Syndrome After Angioplasty

Background: It is required to anticipate cerebral hyperperfusion syndrome (CHS) following carotid artery stenting (CAS). Purpose: The purpose of our retrospective study was to investigate whether or not blood sampling oxygen extraction fraction (OEF) and post-CAS CBF increase in SPECT had relation to CHS following CAS. Methods: Included in our analysis were patients (1) who underwent elective CAS in our institution between October 2010 and May 2014, and (2) who underwent blood sampling for OEF calculation before and immediately after CAS, and (3) who underwent SPECT before and just after CAS. OEF was calculated from cerebral arteriovenous oxygen difference. Arterial blood was sampled from the common carotid artery and venous blood from the dominant-sided superior jugular bulb. CHS was defined as pulsatile headaches, restlessness, convulsion, and/or new neurological symptoms not due to cerebral ischemia within seven days following CAS. CBF was measured before and just after CAS. CBF increase in the CAS side was defined as follows; (post-CAS CBF ratio - pre-CAS CBF ratio) of more than 10%, where CBF ratio was defined as CAS-sided fronto-parietal CBF divided by ipsilateral cerebellar CBF (%). Evaluated were baseline features in patients, pre-CAS OEF, post-CAS OEF, CBF ratio, CBF increase and CHS. Results: During the study period, 134 patients matched our criteria for analysis. Pre-CAS OEF was 0.41+-0.06, post-CAS OEF was 0.42+-0.08, pre-CAS CBF ratio: 88.7+-15.4%, CBF increase: 1.86+-12.3%. Nine patients presented CHS. Among them, pre-CAS OEF, CBF ratio and CBF increase were significant. ROC curves showed that pre-CAS OEF of 0.46 (p<0.001, OR: 9.3), CBF ratio of 92%(p<0.05, OR: 6.5), CBF increase of 8.8% (p<0.005, OR: 6.6) were cut-off values. Among 10 patients with pre-CAS OEF of more than 0.46 and CBF increase of more than 8.8%, 4 patients presented CHS (p<0.0001, OR;15.9). Conclusion: Elevation of pre-CAS OEF and increase of post-CAS CBF were strongly related to CHS.

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Indocyanine green kinetics with near-infrared spectroscopy predicts cerebral hyperperfusion syndrome after carotid artery stenting

PLoS ONE ◽

10.1371/journal.pone.0180684 ◽

2017 ◽

Vol 12 (7) ◽

pp. e0180684 ◽

Cited By ~ 5

Author(s):

Ichiro Nakagawa ◽

Hun Soo Park ◽

Shohei Yokoyama ◽

Shuichi Yamada ◽

Yasushi Motoyama ◽

...

Keyword(s):

Infrared Spectroscopy ◽

Carotid Artery ◽

Indocyanine Green ◽

Near Infrared Spectroscopy ◽

Carotid Artery Stenting ◽

Near Infrared ◽

Cerebral Hyperperfusion Syndrome ◽

Hyperperfusion Syndrome ◽

Cerebral Hyperperfusion

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Cerebral hyperperfusion syndrome after external carotid artery–middle cerebral artery bypass for carotid artery giant aneurysm

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2018.10.041 ◽

2019 ◽

Vol 54 ◽

pp. 41-42

Author(s):

Devika Bharadwaj ◽

Indu Kapoor ◽

Charu Mahajan ◽

Hemanshu Prabhakar

Keyword(s):

Carotid Artery ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Bypass ◽

Giant Aneurysm ◽

External Carotid Artery ◽

External Carotid ◽

Cerebral Hyperperfusion Syndrome ◽

Hyperperfusion Syndrome ◽

Cerebral Hyperperfusion

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Long-Lasting Symptomatic Cerebral Hyperperfusion Syndrome following Superficial Temporal Artery-Middle Cerebral Artery Bypass in a Patient with Stenosis of Middle Cerebral Artery

Case Reports in Neurological Medicine ◽

10.1155/2018/4717256 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Shinji Shimato ◽

Toshihisa Nishizawa ◽

Takashi Yamanouchi ◽

Takashi Mamiya ◽

Kojiro Ishikawa ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Receptor Antagonist ◽

Cerebral Artery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Cerebral Hyperperfusion Syndrome ◽

Speech Disturbance ◽

Hyperperfusion Syndrome ◽

Cerebral Hyperperfusion ◽

Dopamine 2 Receptor

Cerebral hyperperfusion syndrome (CHPS) is a complication that can occur after cerebral revascularization surgeries such as superficial temporal artery- (STA-) middle cerebral artery (MCA) anastomosis, and it can lead to neurological deteriorations. CHPS is usually temporary and disappears within two weeks. The authors present a case in which speech disturbance due to CHPS lasted unexpectedly long and three months was taken for full recovery. A 40-year-old woman, with a history of medication of quetiapine, dopamine 2 receptor antagonist as an antipsychotics for depression, underwent STA-MCA anastomosis for symptomatic left MCA stenosis. On the second day after surgery, the patient exhibited mild speech disturbance which deteriorated into complete motor aphasia and persisted for one month. SPECT showed the increase of cerebral blood flow (CBF) in left cerebrum, verifying the diagnosis of CHPS. Although CBF increase disappeared one month after surgery, speech disturbance continued for additionally two months with a slow improvement. This case represents a rare clinical course of CHPS. The presumable mechanisms of the prolongation of CHPS are discussed, and the medication of quetiapine might be one possible cause by its effect on cerebral vessels as dopamine 2 receptor antagonist, posing the caution against antipsychotics in cerebrovascular surgeries.

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Treatment of postoperative cerebral hyperperfusion syndrome after carotid stenting and carotid endarterectomy ^|^mdash; control of systemic blood pressure based on daily transcranial color-coded sonography evaluation ^|^mdash;

Neurosonology ◽

10.2301/neurosonology.21.117 ◽

2008 ◽

Vol 21 (2) ◽

pp. 117-122

Author(s):

Shin-ya FUKUMOTO ◽

Yoshiaki KUMON ◽

Hideaki WATANABE ◽

Masahiko TAGAWA ◽

Takanori OHNISHI

Keyword(s):

Blood Pressure ◽

Carotid Endarterectomy ◽

Systemic Blood Pressure ◽

Carotid Stenting ◽

Systemic Blood ◽

Cerebral Hyperperfusion Syndrome ◽

Hyperperfusion Syndrome ◽

Cerebral Hyperperfusion

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Uncommon Etiology for Seizure: Cerebral Hyperperfusion Syndrome

Case Reports in Neurological Medicine ◽

10.1155/2017/7965758 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Mohankumar Kurukumbi ◽

Ahn Truong ◽

Naghemeh Pirsaharkhiz

Keyword(s):

White Matter ◽

Carotid Artery ◽

Carotid Stenosis ◽

Rare Complication ◽

Subcortical White Matter ◽

Cerebral Hyperperfusion Syndrome ◽

Hyperperfusion Syndrome ◽

Cerebral Hyperperfusion ◽

Bilateral Carotid ◽

The Right

Cerebral hyperperfusion syndrome (CHS) is a rare life-threatening complication of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid artery stenosis. The incidence varies between 0 and 3%, depending on the severity of the stenosis, perioperative hypertension, and contralateral carotid stenosis. This case report reports a 53-year-old female patient presenting with decreased alertness and multiple tonic-clonic seizures, in the background of bilateral CEA. She was found to have bilateral carotid stenosis. Her left CEA was performed three months prior and right CEA was four days prior to her current presentation with seizures. After bilateral CEA, the imaging showed extensive pathologic process involving primarily the subcortical white matter and overlying cortex, more on the right cerebral hemisphere. On follow-up six weeks later, she reported no recurrent seizures and imaging showed decrease in abnormal signal intensity of the grey and white matter. This was indicative of near complete resolution of hyperperfusion damage. CHS is a rare complication due to the loss of autoregulation of the cerebrovascular system and increased blood flow status after bilateral CEA. This case is reported because of a rare and unique presentation of seizures in the background of bilateral CEA.

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