Reversible cerebral hyperperfusion syndrome after stenting of the carotid artery - two case reports
1Kardiologie am Krankenhaus Agatharied, Akademisches Lehrkrankenhaus der LMU München, St.-Agatha-Str. 1, 83734, Hausham, Germany. pilz@khagatharied.de
Insights
Hyperperfusion syndrome, a complication of carotid artery stenting (CAS), can cause brain edema. Conservative therapy effectively managed symptoms in two severe stenosis cases, leading to full recovery.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Hyperperfusion syndrome is a known complication of carotid revascularization procedures like carotid artery stenting (CAS).
- Limited data exists on the incidence, causes, and prevention of hyperperfusion following CAS.
- Severe internal carotid artery stenosis (>90%) presents a significant risk for cerebrovascular events.
Observation:
- Two female patients (72 and 81 years) with severe internal carotid stenosis underwent CAS.
- Both patients developed unilateral hyperperfusion syndrome confirmed by CT scan shortly after stenting.
- Symptoms included acute cerebral edema in one patient and focal edema in the other.
Findings:
- Carotid artery stenting in severe stenosis can precipitate hyperperfusion syndrome.
- Computed tomography confirmed cerebral edema as a manifestation of hyperperfusion.
- Early identification and intervention are crucial for managing post-CAS hyperperfusion.
Implications:
- Conservative management appears effective for resolving hyperperfusion syndrome post-CAS.
- Prompt recognition and treatment can lead to favorable neurological outcomes and full patient recovery.
- Further research is needed to establish standardized prevention and treatment protocols for CAS-related hyperperfusion.
Abstract:
Hyperperfusion syndrome can complicate carotid revascularization, be it endarterectomy or carotid artery stenting (CAS). Although extensive effort has been devoted to reducing the incidence of ischemic stroke complicating CAS, little is known about the incidence, etiology, and prevention strategies for hyperperfusion following CAS. We report two cases (female patients 72 and 81 years) presenting severe internal carotid stenosis (> 90%), who underwent presurgical and therapeutic intervention with CAS. Both patients developed hyperperfusion symptoms at 2 hours and at 30 minutes, respectively, following stenting, in both cases unilateral hyperperfusion was CCT confirmed. Case 1 was presenting with acute edema of the right hemisphere, case 2 with distended focal edema (left fronto-temporoparietally). Hyperperfusion syndrome and neurological symptoms retroceded in both cases (conservative therapy) and both patients returned to full activity (case 2 within 48 hours).
Related Concept Videos
01:15Ischemic Stroke ll: Pathophysiology
01:26Transient Ischemic Attack l: Introduction