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


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

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