颈动脉支架成形术后脑高灌注综合征

doi:10.19723/j.issn.1671-167X.2019.04.024

北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (4): 733-736. doi: 10.19723/j.issn.1671-167X.2019.04.024

颈动脉支架成形术后脑高灌注综合征

贾子昌¹,卞焕菊²,韩金涛¹,赵海燕³,栾景源¹,王昌明¹,李选^1,^△()

1. 北京大学第三医院介入血管外科, 北京　100191
2. 山东省冠县人民医院神经内科, 山东冠县　252500
3. 北京大学第三医院神经内科, 北京　100191

收稿日期:2018-05-08 出版日期:2019-08-18 发布日期:2019-09-03
通讯作者: 李选 E-mail:xuanli@vip.sina.com

Cerebral hyper perfusion syndrome after carotid artery stenting

Zi-chang JIA¹,Huan-ju BIAN²,Jin-tao HAN¹,Hai-yan ZHAO³,Jing-yuan LUAN¹,Chang-ming WANG¹,Xuan LI^1,^△()

1.Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
2. Department of Neurology,Guanxian Hospital,Guanxian 252500, Shandong, China
3.Department of Neurology, Peking University Third Hospital, Beijing 100191, China

Received:2018-05-08 Online:2019-08-18 Published:2019-09-03
Contact: Xuan LI E-mail:xuanli@vip.sina.com

摘要/Abstract

摘要：

目的:探讨颈内动脉重度狭窄患者行颈动脉支架成形术(carotid artery stenting,CAS)后,发生脑高灌注综合征(hyper perfusion syndrome,HPS)的危险因素、临床特点以及防治方法。方法:选择2014年9月至2018年3月于北京大学第三医院介入血管外科接受CAS治疗的226例颈内动脉重度狭窄患者进行回顾性分析,总结其中发生HPS的5例患者的相关临床资料,分析其临床基线资料、影像学特点以及围手术期管理与HPS的关系。结果:226例行CAS手术的患者中5例发生了HPS(2.21%,5/226),其中2例为高灌注性脑出血(0.88%,2/226), 5例中男性4例,女性1例,年龄58~74岁。发生HPS时间在术后第4小时至术后第3天,症状为头痛2例,谵妄1例,左侧肢体偏瘫1例,昏迷(最终死亡)1例。结论:HPS是CAS术后少见但后果严重的并发症,应增强对其危险因素的认识,预防其发生,一旦发生则早诊断、早治疗尤为重要。

关键词: 脑高灌注综合征, 颈动脉支架成形术, 高灌注性脑出血

Abstract:

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.

Key words: Cerebral hyper perfusion syndrome, Carotid artery stenting, Hyper perfusion induced intracranial hemorrhage

中图分类号:

R619

贾子昌,卞焕菊,韩金涛,赵海燕,栾景源,王昌明,李选. 颈动脉支架成形术后脑高灌注综合征[J]. 北京大学学报（医学版）, 2019, 51(4): 733-736.

Zi-chang JIA,Huan-ju BIAN,Jin-tao HAN,Hai-yan ZHAO,Jing-yuan LUAN,Chang-ming WANG,Xuan LI. Cerebral hyper perfusion syndrome after carotid artery stenting[J]. Journal of Peking University(Health Sciences), 2019, 51(4): 733-736.

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参考文献 11

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Case	Gender	Age/years	Preoperative symptoms	Location	Rate of stenosis	Collateral circulation	Clinical feature	Postoperative period
1	M	63	TIA	Right	90%	3 grade	Headache	4 th hour
2	M	58	TIA	Left	95%	2 grade	Headache	7 th hour
3	F	67	IS	Left	90%	2 grade	Deliration	8 th hour
4	M	73	TIA	Right	99%	3 grade	Hemiplegia	5 th hour
5	M	74	IS	Right	99%	3 grade	Death	3 rd day

Case	Gender	Age/years	Preoperative medication	Intraoperative medication	Balloon diameter/mm	Stent diameter/mm²
1	M	63	2 antiplatelet agents	Heparin 3000 U	5.0	8×30
2	M	58	2 antiplatelet agents	Heparin 3000 U	4.5	7×40
3	F	67	2 antiplatelet agents	Heparin 3000 U	5.0	7×30
4	M	73	2 antiplatelet agents	Heparin 3000 U	4.0	7×50
5	M	74	2 antiplatelet agents	Heparin 3000 U	4.5	8×40

颈动脉支架成形术后脑高灌注综合征

Cerebral hyper perfusion syndrome after carotid artery stenting

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