Vol 23, No 1-2 (2021)
Research paper
Published online: 2022-12-30
Get Citation

Prospective observation of neurological symptoms attributable to cerebral hyperfusion syndrome after CEA and CAS

Damian Ziaja12, Mariola Sznapka34, Grzegorz Biolik5, Anetta Lasek-Bal6, Danuta Gierek7, Wacław Kuczmik8, Tomasz Gul9, Jerzy Chudek10, Krzysztof Ziaja114
·
Chirurgia Polska 2021;23(1-2):11-16.
Affiliations
  1. Department of Physiotherapy Medical University of Silesia in Katowice
  2. Department of General and Oncological Surgery, MEGREZ Tychy
  3. Department of General, Vascular Surgery, Angiology and Phlebology Faculty of Katowice Medical University of Silesia
  4. Katowice Business University Medical Science Faculty
  5. Department of General, Vascular Surgery, Angiology and Phlebology Faculty of Katowice Medical University of Silesia
  6. Department of Stroke and Neurology SPSK n. 7 , Katowice
  7. Department of Intensive Therapy and Anesthesiology SPSK n. 7, Katowice
  8. Department of General, Vascular Surgery, Angiology and Phlebology Faculty of Katowice Medical University of Silesia
  9. Department of General, Vascular Surgery, Angiology and Phlebology Faculty of Katowice Medical University of Silesia
  10. Department of Internal and Onkological Medicine WLK SUM, Katowice
  11. Department of General and Oncological Surgery, MEGREZ, Tychy

paid access

Vol 23, No 1-2 (2021)
Original articles
Published online: 2022-12-30

Abstract

Introduction: Neurological symptoms are considered as most clinically significant symptoms with various
pathogenesis, including cerebral hyperperfusion syndrome (CHS) and microembolism, in patients shortly
after endarterectomy (CEA) and stenting (CAS) for internal carotid artery stenosis (ICA).

Aim: This study aimed to compare the structure of neurological symptoms attributable to CHS after carotid
artery revascularization collected retrospectively and prospectively in large patient cohorts.

Material and methods: Prospective analysis included 1047 consecutive patients treated with CEA (n =
477) or CSA (n = 570) in a single centre from 2011 to 2015. In 2012 was introduced strict monitoring of
pain in patients with headache and blood pressure (BP) and more intensive antihypertensive treatment in
patients with an increase in BP post-procedure. The occurrence of neurological symptoms attributable to
CHS was compared with a historical, retrospectively analysed less strictly monitored cohort (n = 1386).

Results: Neurological symptoms attributed to CHS were observed less frequently in prospectively than
retrospectively analysed cohort: 8.3% vs 10.6% (p = 0.03) of CEA and 5.7% vs 8.0% (p = 0.10) of CAS
group, respectively. The profile of neurological symptoms was similar in both cohorts. The prospective
analysis revealed more episodes of transient bradycardia and/or hypotension in the CAS group (10.4 vs
8.8% and 11.2 vs 9.2%, respectively).

Conclusion: The incidence of neurological symptoms attributable to cerebral hyperperfusion syndrome
after carotid artery revascularization in short-term observation is similar regardless of the method used.
Strict monitoring of BP slightly decreased the prevalence of neurological symptoms after carotid artery
revascularization.

Abstract

Introduction: Neurological symptoms are considered as most clinically significant symptoms with various
pathogenesis, including cerebral hyperperfusion syndrome (CHS) and microembolism, in patients shortly
after endarterectomy (CEA) and stenting (CAS) for internal carotid artery stenosis (ICA).

Aim: This study aimed to compare the structure of neurological symptoms attributable to CHS after carotid
artery revascularization collected retrospectively and prospectively in large patient cohorts.

Material and methods: Prospective analysis included 1047 consecutive patients treated with CEA (n =
477) or CSA (n = 570) in a single centre from 2011 to 2015. In 2012 was introduced strict monitoring of
pain in patients with headache and blood pressure (BP) and more intensive antihypertensive treatment in
patients with an increase in BP post-procedure. The occurrence of neurological symptoms attributable to
CHS was compared with a historical, retrospectively analysed less strictly monitored cohort (n = 1386).

Results: Neurological symptoms attributed to CHS were observed less frequently in prospectively than
retrospectively analysed cohort: 8.3% vs 10.6% (p = 0.03) of CEA and 5.7% vs 8.0% (p = 0.10) of CAS
group, respectively. The profile of neurological symptoms was similar in both cohorts. The prospective
analysis revealed more episodes of transient bradycardia and/or hypotension in the CAS group (10.4 vs
8.8% and 11.2 vs 9.2%, respectively).

Conclusion: The incidence of neurological symptoms attributable to cerebral hyperperfusion syndrome
after carotid artery revascularization in short-term observation is similar regardless of the method used.
Strict monitoring of BP slightly decreased the prevalence of neurological symptoms after carotid artery
revascularization.

Get Citation

Keywords

cerebral hyperperfusion syndrome (CHS); carotid artery revascularization; carotid endarterectomy (CEA); carotid artery stenting (CAS)

About this article
Title

Prospective observation of neurological symptoms attributable to cerebral hyperfusion syndrome after CEA and CAS

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 23, No 1-2 (2021)

Article type

Research paper

Pages

11-16

Published online

2022-12-30

Page views

3082

Article views/downloads

15

DOI

10.5603/ChP.2021.0007

Bibliographic record

Chirurgia Polska 2021;23(1-2):11-16.

Keywords

cerebral hyperperfusion syndrome (CHS)
carotid artery revascularization
carotid endarterectomy (CEA)
carotid artery stenting (CAS)

Authors

Damian Ziaja
Mariola Sznapka
Grzegorz Biolik
Anetta Lasek-Bal
Danuta Gierek
Wacław Kuczmik
Tomasz Gul
Jerzy Chudek
Krzysztof Ziaja

References (38)
  1. Chambers BR, Donnan GA, Chambers BR, et al. Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev. 2000(2): CD001923.
  2. Cina CS, Clase CM, Haynes RB. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev 2000(2):CD001081. .
  3. CAVATAS Investigators. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Lancet. 2001; 357: 1729–1737.
  4. Yadav JS, Wholey MH, Kuntz RE, et al. Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy Investigators. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004; 351(15): 1493–1501.
  5. Newman JE, Ali M, Sharpe R, et al. Seizures after carotid endarterectomy: hyperperfusion, dysautoregulation or hypertensive encephalopathy? Eur J Vasc Endovasc Surg. 2003; 26(1): 39–44.
  6. Jørgensen LG, Schroeder TV. Defective cerebrovascular autoregulation after carotid endarterectomy. Eur J Vasc Surg. 1993; 7(4): 370–379.
  7. Schwartz RB. Hyperperfusion encephalopathies: hypertensive encephalopathy and related conditions. Neurologist. 2002; 8(1): 22–34.
  8. 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 ischaemia. Mayo Clin Proc. 1981; 56: 533–543.
  9. McCabe DJ, Brown MM, Clifton A. Fatal cerebral reperfusion hemorrhage after carotid stenting. Stroke. 1999; 30(11): 2483–2486.
  10. Wu T, Anderson N, Barber P. Neurological complications of carotid revascularization. J Neurol Neurosurg Psychiatry. 2012; 83: 543–550.
  11. Dunne VG, Besser M, Ma WJ. Transcranial Doppler in carotid endarterectomy. J Clin Neurosci. 2001; 8(2): 140–145.
  12. Beard JD, Mountney J, Wilkinson JM, et al. Prevention of postoperative wound haematomas and hyperperfusion following carotid endarterectomy. Eur J Vasc Endovasc Surg. 2001; 21(6): 490–493.
  13. Ziaja D, Biolik G, Kocełak P, et al. Ziaja K. Neurological symptoms associated with cerebral hyperperfusion syndrome after CEA and CAS – one center study. Eur Rev Med Pharmacol Sci. 2014; 18: 1176–1180.
  14. Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997; 26(3): 517–538.
  15. Denzel C, Balzer K, Müller KM, et al. Relative value of normalized sonographic in vitro analysis of arteriosclerotic plaques of internal carotid artery. Stroke. 2003; 34(8): 1901–1906.
  16. Ogasawara K, Sakai N, Kuroiwa T, et al. Japanese Society for Treatment at Neck in Cerebrovascular Disease Study Group. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients. J Neurosurg. 2007; 107(6): 1130–1136.
  17. Brantley HP, Kiessling JL, Milteer HB, et al. Hyperperfusion syndrome following carotid artery stenting: the largest single-operator series to date. J Invasive Cardiol. 2009; 21(1): 27–30.
  18. Coutts SB, Hill MD, Hu WY. Hyperperfusion syndrome: toward a stricter definition. Neurosurgery. 2003; 53: 1053–1060.
  19. Meyers PM, Higashida RT, Phatouros CC, et al. Cerebral hyperperfusion syndrome after percutaneous transluminal stenting of the craniocervical arteries. Neurosurgery. 2000; 47(2): 335–43; discussion 343.
  20. Abou-Chebl A, Reginelli J, Bajzer CT, et al. Intracranial hemorrhage and hyperperfusion syndrome following carotid artery stenting: risk factors, prevention, and treatment. J Am Coll Cardiol. 2004; 43(9): 1596–1601.
  21. Shields RC. Medical management of carotid stenosis. Perspect Vasc Surg Endovasc Ther. 2010; 22(1): 18–27.
  22. Yoshimoto T, Shirasaka T, Yoshizumi T, et al. Evaluation of carotid distal pressure for prevention of hyperperfusion after carotid endarterectomy. Surg Neurol. 2005; 63(6): 554–7; discussion 557.
  23. Karapanayiotides T, Meuli R, Devuyst G, et al. Postcarotid endarterectomy hyperperfusion or reperfusion syndrome. Stroke. 2005; 36(1): 21–26.
  24. van Mook WN, Rennenberg RJ, Schurink GW, et al. Cerebral hyperperfusion syndrome. Lancet Neurol. 2005; 4(12): 877–888.
  25. Tehindrazanarivelo AD, Lutz G, PetitJean C, et al. Headache following carotid endarterectomy: a prospective study. Cephalalgia. 1992; 12(6): 380–382.
  26. Qureshi AI, Luft AR, Sharma M, et al. Frequency and determinants of postprocedural hemodynamic instability after carotid angioplasty and stenting. Stroke. 1999; 30(10): 2086–2093.
  27. Harrop JS, Sharan AD, Benitez RP, et al. Prevention of carotid angioplasty-induced bradycardia and hypotension with temporary venous pacemakers. Neurosurgery. 2001; 49(4): 814–20; discussion 820.
  28. Hines LH, DeCrosta D, Kantaria S, et al. Ch., Islam S. Postendarterectomy cerebral hyperperfusion sundrome: the etiological significance of “cerebral Reserve”. Int.J.Angiol 2014; (4) 23:125–130. .
  29. Mondel PK, Udare AS, Anand SV, et al. Recurrent cerebral hyperperfusion syndrome after intracranial angioplasty and stenting: case report with review of literature. Cardiovasc Intervent Radiol. 2014; 37(4): 1087–1092.
  30. Isozaki M, Arai Y, Higashino Y, et al. Cerebral hyperperfusion syndrome resulting in subarachnoid hemorrhage after carotid artery stenting. Ann Nucl Med. 2016; 30(9): 669–674.
  31. Oh SI, Lee SJ, Lee YJ, et al. Delayed cerebral hyperperfusion syndrome three weeks after carotid artery stenting presenting as status epilepticus. J Korean Neurosurg Soc. 2014; 56(5): 441–443.
  32. Lin TW, Wang JN. Kan ChD. Cerebral hyperperfusion sundrome after surgical repair congenital supravascu;ar aortic stenosis. Ann Thorac Surg. 2015; 100: 51.
  33. Narita S, Aikawa H, Nagata SI, et al. Intraprocedural prediction of hemorrhagic cerebral hyperperfusion syndrome after carotid artery stenting. J Stroke Cerebrovasc Dis. 2013; 22(5): 615–619.
  34. Mass M, Kwolek HJ, Hirsch JA, et al. Clinicl risk predictors for cerebral hyperperfusion syndrome after carotid endarterectomy. J Neurol Neurosurg Psychiatry. 2013; 84: 569–72.
  35. Lai ZH, Liu B, Chen Y, et al. Prediction of vertebral hyperperfusion syndrome with velocity blood pressure index. http//www.cmj.org on January 18. 2017 , IP 213 227. ; 113: 51.
  36. Kim KH, Lee CH, Son YJ, et al. Post-carotid endarterectomy cerebral hyperperfusion syndrome : is it preventable by strict blood pressure control? J Korean Neurosurg Soc. 2013; 54(3): 159–163.
  37. Fujimoto M, Itokawa H, Moriya M, et al. Evaluation of Cerebral Hyperperfusion After Carotid Artery Stenting Using C‑Arm CT Measurements of Cerebral Blood Volume. Clin Neuroradiol. 2018; 28(2): 253–260.
  38. Lin YH, Liu HM. Update on cerebral hyperperfusion syndrome. J Neurointerv Surg. 2020; 12(8): 788–793.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Via MedicaBy Via Medicav Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl