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Published on: May 14, 2013
[Cerebral hyper perfusion syndrome after carotid artery stenting]
1Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China.
Insights
Hyper perfusion syndrome (HPS) is a rare but serious complication following carotid artery stenting (CAS). Early recognition and prompt treatment are crucial for managing HPS and preventing severe outcomes like intracranial hemorrhage.
Area of Science:
- Vascular Surgery
- Neurology
- Interventional Radiology
Background:
- Carotid artery stenting (CAS) is a common procedure for severe carotid stenosis.
- Hyper perfusion syndrome (HPS) is a potential complication after CAS, characterized by excessive blood flow to the brain.
- Understanding the risk factors and clinical presentation of HPS is vital for patient safety.
Purpose of the Study:
- To investigate the risk factors, clinical characteristics, and management strategies for hyper perfusion syndrome (HPS) after carotid artery stenting (CAS).
- To analyze the incidence and outcomes of HPS and hyper perfusion induced intracranial hemorrhage (HICH) in patients undergoing CAS.
Main Methods:
- Retrospective analysis of clinical data from 226 patients who underwent CAS for severe carotid stenosis (70%-99%) between September 2014 and March 2018.
- Assessment of the relationship between clinical baseline data, imaging characteristics, and perioperative management with the development of HPS.
- Detailed review of the 5 cases that developed HPS post-CAS.
Main Results:
- Five patients (2.21%) developed HPS after CAS, with two (0.88%) experiencing hyper perfusion induced intracranial hemorrhage (HICH).
- HPS symptoms manifested within 4 hours to 3 days post-CAS, including headache, delirium, hemiparesis, and coma.
- One patient with HPS ultimately died due to massive cerebral hemorrhage.
Conclusions:
- Hyper perfusion syndrome (HPS) is an uncommon yet significant complication associated with carotid artery stenting (CAS).
- Increased awareness and vigilance for HPS are necessary among clinicians.
- Early diagnosis and prompt intervention are critical for improving outcomes in patients with HPS.
Objective:
To explore the risk factors, clinical characteristics, precaution and treatment of hyper perfusion syndrome (HPS) after carotid artery stenting (CAS).
Methods:
From September 2014 to March 2018, the clinical data of 226 patients with severe carotid stenosis (70%-99%) treated with carotid artery stenting (CAS)at Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, were analyzed retrospectively．Five of them developed HPS after CAS．The relationship between the clinical baseline data, imaging characteristics, perioperative management and HPS were assessed.
Results:
In this group, 5 patients of them (2.21%, 5/226) developed HPS after CAS, and 2 patients of them (0.88%, 2/226) were hyper perfusion induced intracranial hemorrhage (HICH). The 5 patients consisted of 4 men and 1 woman whose age ranged from 58 to 74 years. The symptoms of HPS occurred within 4 hours to 3 days after CAS. Among the 5 cases, the clinical manifestations were that 2 cases with headache, 1 case with delirium,1 case with hemiparesis of left limbs, and 1 case with coma(died ultimately).The main manifestations of case 1 and case 2 were headache in the frontal parietal temporal region of the operative side, accompanied by nausea and vomiting. The symptoms were relieved after blood pressure lowering treatment and mannitol dehydration. The main manifestations of case 3 were excitement and delirium. The symptoms were relieved by a small dose of sedatives, also with blood pressure lowering treatment and mannitol dehydration. The initial symptoms of case 4 were excitement and delirium, accompanied by mild headache of the operative side, and hemiplegia of the contralateral limb occurred within a short time. The main manifestation of case 5 was severe headache and went into deep coma within a short time. This patient died of massive cerebral hemorrhage ultimately.
Conclusion:
HPS is an uncommon but serious complication after CAS. Improving our understanding and heightening vigilance of HPS is necessary. The earlier diagnosis, the earlier treatment.
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