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Hyperperfusion syndrome: toward a stricter definition.

Shelagh B Coutts¹, Michael D Hill, William Y Hu

¹Department of Clinical Neurosciences, University of Calgary, and Seaman Family MR Research Centre, Calgary, Alberta, Canada. shelagh.coutts@calgaryhealthregion.ca

|October 29, 2003

Summary

Hyperperfusion syndrome, a complication of carotid revascularization, presents more variably than previously thought. This review details its occurrence and diverse clinical manifestations after endarterectomy and stenting.

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Area of Science:

Neurology
Vascular Surgery
Neurosurgery

Background:

Hyperperfusion syndrome is a rare but serious complication following carotid endarterectomy or angioplasty with stenting.
Newer imaging modalities prompt a review of this phenomenon's incidence and presentation.

Observation:

A retrospective review of 129 carotid endarterectomies and 44 carotid artery stenting procedures was conducted.
Seven cases of hyperperfusion syndrome were identified: four after endarterectomy (3.1%) and three after stenting (6.8%).

Findings:

Presentations included acute focal edema with stroke-like symptoms, acute intracerebral hemorrhage, and delayed seizures or hemorrhage.
The syndrome manifested acutely or with delayed symptoms at least 24 hours post-procedure.

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Implications:

Hyperperfusion syndrome may be underdiagnosed due to its varied clinical presentation.
Recognizing these diverse presentations is crucial for timely diagnosis and management of post-carotid revascularization complications.