[Risk analysis for cerebral hyperperfusion syndrome after carotid endarterectomy]
Leng Ni1, Chang-Wei Liu1, Li-Ying Cui1
1Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing 100730, China.
Insights
Symptomatic carotid artery stenosis increases cerebral hyperperfusion syndrome (CHS) risk after carotid endarterectomy (CEA). Using shunts during CEA surgery may protect against CHS.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Cerebral hyperperfusion syndrome (CHS) is a potential complication following carotid endarterectomy (CEA).
- Identifying risk factors for CHS is crucial for patient safety and improving surgical outcomes.
- Understanding the role of intraoperative factors in CHS development is essential.
Purpose of the Study:
- To investigate the risk factors associated with the development of cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy (CEA).
- To identify independent predictors and protective factors for CHS post-CEA.
Main Methods:
- A cohort of 183 patients undergoing CEA for carotid artery stenosis were monitored.
- Transcranial Doppler was used to assess middle cerebral artery velocity (VMCA) changes pre- and post-operatively.
- Logistic regression analysis was employed to determine risk factors for CHS.
Main Results:
- Cerebral hyperperfusion syndrome (CHS) occurred in 8.2% of patients post-CEA.
- Symptomatic carotid artery stenosis was identified as an independent risk factor for CHS (OR = 6.733).
- Intraoperative shunting during CEA demonstrated a protective effect against CHS (OR = 0.252).
Conclusions:
- Symptomatic carotid artery stenosis is a significant independent risk factor for CHS after CEA.
- The use of shunts during carotid endarterectomy appears to be a protective measure against CHS.
- Implementing shunting strategies may effectively reduce the incidence of CHS post-CEA.
Objective:
To analyze risk factors for cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy (CEA).
Methods:
From September 2010 to September 2012, 183 consecutive patients with carotid artery stenosis who had indications for CEA entered the study. There were 149 male and 34 female patients, aged from 38 to 83 years with an average of (66 ± 9) years. Intracranial blood flow changes were monitored through transcranial Doppler routinely. Pre- and post-operative middle cerebral artery velocity (VMCA) were recorded. CHS was diagnosed by the combination of hyperperfusion syndrome and 100% increase of VMCA after operation compared with pre-operative baseline values. The patients who had CHS during hospitalization were recorded. Pre-operative and operative related factors were analyzed by univariate analysis, followed by Logistic regression model, to identify the risk factors of CHS.
Results:
Overall, CHS occurred in 15 patients (8.2%) after CEA. The average onset time was (2.6 ± 0.2) days after surgery. By decreasing blood pressure and using dehydration medicine, all the patients with CHS recovered before discharge. None of them developed to intracranial hemorrhage. On univariate analysis, significant risk factors for CHS were history of stoke, symptomatic carotid artery stenosis and shunting during operation. On Logistic regression model, independent risk factor was symptomatic carotid artery stenosis (OR = 6.733, 95%CI: 1.455-31.155, P = 0.015), while shunting during operation (OR = 0.252, 95%CI: 0.067-0.945, P = 0.041) was a protective factor.
Conclusions:
Symptomatic carotid artery stenosis is an independent risk factor for CHS after CEA and shunting during operation is a protective factor. Using shunt may be an effective method of preventing CHS after CEA.
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