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Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective
Alejandro González García1, Francisco Moniche2, Irene Escudero-Martínez2
1Interventional Neuroradiology, Department of Radiology, Hospital Virgen del Rocío, Sevilla, Spain; Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain.
Insights
Cerebral hyperperfusion syndrome (CHS) occurred in 2.9% of patients after carotid artery stenting (CAS). Female sex, older age, and left artery treatment predict moderate-severe CHS risk.
Area of Science:
- Neurology
- Vascular Surgery
- Clinical Research
Background:
- Cerebral hyperperfusion syndrome (CHS) is a serious complication following carotid artery stenting (CAS).
- Previous estimates of CHS clinical manifestations are uncertain, often based on retrospective reviews.
- The HISPANIAS study aimed to prospectively define CHS rates and identify predictive factors.
Purpose of the Study:
- To determine the incidence of cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS).
- To develop a clinical predictive model for CHS following CAS.
- To identify pre-operative predictors of moderate-severe CHS.
Main Methods:
- A prospective, national, multicenter study involving 14 hospitals.
- Inclusion of 757 carotid artery stenting (CAS) procedures.
- Classification of CHS as mild (headache) or moderate-severe (seizure, altered consciousness, focal neurological signs).
Main Results:
- The overall incidence of CHS was 2.9% (22/757 patients), with 2.1% (16/757) classified as moderate-severe.
- Hemorrhage occurred in 0.7% of patients, associated with a 20% mortality rate.
- Predictors of moderate-severe CHS included female sex, older age, left carotid artery treatment, and chronic renal failure (p < 0.05 for all).
Conclusions:
- The incidence of CHS post-CAS was 2.9%, with moderate-severe cases at 2.1%.
- CHS is independently associated with female sex, advanced age, chronic kidney disease, and left carotid artery stenting.
- A predictive model with an AUC of 0.86 was developed to identify high-risk patients, aiding in future risk-reduction strategies.
Objectives:
The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS).
Background:
CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain.
Methods:
The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs).
Results:
A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001).
Conclusions:
The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.
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