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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (4): 733-736. doi: 10.19723/j.issn.1671-167X.2019.04.024

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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 LI1,△()   

  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

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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

CLC Number: 

  • R619

Table 1

The general clinical information in the 5 patients"

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

Table 2

Perioperative information in the 5 patients"

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

Figure 1

DSA image of the fifth case,the black arrow showed the lesion in subtotal occlusion. Forward flow in the internal carotid artery is much slower than the external carotid artery"

Figure 2

DSA image of the fifth case,the black arrow showed the eradicated lesion(stenosis removing) after operation"

Figure 3

The third day after CAS of the fifth case:CT showed large hemotoma of the right brain with midline shift"

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