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Clinical risk predictors for cerebral hyperperfusion syndrome after carotid endarterectomy

Matthew B Maas1, Christopher J Kwolek, Joshua A Hirsch

  • 1Division of Critical Care Neurology, Department of Neurology, Northwestern University, 710 N Lake Shore Drive, 11th Floor, Chicago, IL 60611, USA. mbmaas@northwestern.edu

Journal of Neurology, Neurosurgery, and Psychiatry
|December 18, 2012
PubMed

Insights

Cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy (CEA) is rare. A short interval between stroke symptoms and surgery is the clearest risk factor for developing CHS.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Clinical Outcomes Research

Background:

  • Cerebral hyperperfusion syndrome (CHS) is a significant complication following carotid endarterectomy (CEA).
  • Previous research on CHS is limited by small sample sizes, retrospective designs, and reliance on radiographic rather than clinical definitions.

Purpose of the Study:

  • To prospectively monitor carotid endarterectomy (CEA) outcomes at a major academic medical center.
  • To identify clinical risk factors associated with the development of cerebral hyperperfusion syndrome (CHS) post-CEA.

Main Methods:

  • A prospective monitoring system was implemented, with independent neurology monitors assessing patients preoperatively and at 24 hours and 30 days post-CEA.
  • Clinical variables were analyzed to determine risk factors for CHS, defined by specific postoperative neurological events.
  • 841 carotid endarterectomies (CEA) were monitored between 2008 and 2010.

Main Results:

  • Cerebral hyperperfusion syndrome (CHS) occurred in 1.7% of patients (14/841), with seizures in 0.6% and intracerebral hemorrhage in 0.5%.
  • Univariate analysis suggested potential risk factors including dyslipidemia, coronary artery disease, diastolic blood pressure, intraoperative shunt use, and non-elective CEA.
  • Logistic regression confirmed non-elective CEA as a significant risk factor for CHS (p=0.046).

Conclusions:

  • Prospective monitoring of a large cohort revealed a brief time interval between ischemic symptoms and endarterectomy as the primary risk factor for CHS.
  • Non-elective carotid endarterectomy (CEA) is associated with an increased risk of cerebral hyperperfusion syndrome (CHS).
Abstract

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