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Incidence and Clinical Features of Symptomatic Cerebral Hyperperfusion Syndrome After Vascular Reconstruction


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Title: Incidence and Clinical Features of Symptomatic Cerebral Hyperperfusion Syndrome After Vascular Reconstruction
Authors: Hayashi, Kentaro / Horie, Nobutaka / Suyama, Kazuhiko / Nagata, Izumi
Issue Date: Nov-2012
Publisher: Elsevier Inc.
Citation: World Neurosurgery, 78(5), pp.447-454; 2012
Abstract: Background: Vascular reconstructions are the established treatment for ischemic cerebrovascular disease. Cerebral hyperperfusion syndrome (CHS) is occasionally seen after vascular reconstruction and manifest clinical symptoms. The purpose of this study is to investigate the incidence and clinical features of CHS after vascular reconstruction. Methods: A total of 144 patients with ischemic cerebrovascular disease (53 carotid endarterectomy [CEA] for carotid artery stenosis, 48 carotid artery stenting [CAS] for carotid artery stenosis, 20 bypass surgery for atherosclerotic cerebrovascular disease, 40 bypass surgery for moyamoya disease [MMD]) underwent vascular reconstruction. Patients were examined neurologically and radiologically, including computed tomography, magnetic resonance imaging, and single-photon-emission computed tomography, and then CHS was evaluated. Results: CHS developed in 1 (1.9%) CEA, 1 (2.1%) CAS, 1 (5.0%) bypass surgery for atherosclerotic cerebrovascular disease, and 6 (15.0%) bypass surgery for MMD. The incidence of CHS was significantly higher in patients with MMD. Aged patients and impairment of cerebrovascular reserve were correlated with CHS. Patients manifested disorientation after CEA and complained of headache after CAS. Diffuse hemispheric hyperperfusion was detected by single-photon-emission computed tomography. However, MMD patients manifested focal neurologic deficit, focal cerebral edema, and increased regional cerebral blood flow around vascular anastomosis. These patients were treated with blood pressure control and administration of free radical scavengers, and recovered without permanent deficits. Conclusions: The incidence of CHS is significantly higher in patients with MMD and results in vasogenic edema visible on magnetic resonance imaging.
Keywords: Carotid artery stenting / Carotid endarterectomy / Cerebral hyperperfusion syndrome / Moyamoya disease / Vascular reconstruction
URI: http://hdl.handle.net/10069/31018
ISSN: 18788750
DOI: 10.1016/j.wneu.2011.10.041
Rights: © 2012 Elsevier Inc. / NOTICE: this is the author’s version of a work that was accepted for publication in World Neurosurgery. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in World Neurosurgery, 78, 5(2012)
Type: Journal Article
Text Version: author
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/31018

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