[Cerebral hyperperfusion syndrome in carotid revascularisation surgery]

Area of Science:

• Neurology
• Vascular Surgery
• Critical Care Medicine

Background:

• Cerebral hyperperfusion syndrome (CHS) is a significant complication following carotid revascularisation procedures, including endarterectomy and stenting.
• It involves a rapid increase in cerebral blood flow exceeding 100% of pre-operative levels.
• CHS can lead to severe outcomes such as brain edema, hemorrhage, and death if not promptly addressed.

Purpose of the Study:

• To conduct a comprehensive literature review on Cerebral Hyperperfusion Syndrome (CHS).
• To update current knowledge regarding the incidence, pathophysiology, clinical presentation, risk factors, diagnosis, and management of CHS.
• To provide a consolidated resource for specialists managing patients at risk of this complication.

Main Methods:

• Literature search of published studies on Cerebral Hyperperfusion Syndrome (CHS).
• Analysis of pathophysiological mechanisms, including cerebrovascular autoregulation and post-operative hypertension.
• Review of diagnostic criteria, risk factors, and treatment strategies, emphasizing prevention.

Main Results:

• CHS is characterized by headache, convulsions, and focal neurological deficits, accompanied by hypertension and absence of cerebral ischemia.
• Key risk factors include diminished hemodynamic reserve, post-operative hypertension, and prolonged hyperperfusion.
• Diagnosis relies on clinical suspicion supported by imaging like transcranial Doppler ultrasonography or SPECT.

Conclusions:

• Cerebral Hyperperfusion Syndrome (CHS) is an under-diagnosed yet serious complication of carotid revascularisation.
• Awareness and early diagnosis by specialists are essential for timely intervention.
• Strict control of arterial blood pressure is the cornerstone of CHS prevention and management, reducing associated morbidity and mortality.