J Korean Neurosurg Soc.  2013 Sep;54(3):159-163. 10.3340/jkns.2013.54.3.159.

Post-Carotid Endarterectomy Cerebral Hyperperfusion Syndrome : Is It Preventable by Strict Blood Pressure Control?

• Kim KH
• Lee CH
• Son YJ
• Yang HJ
• Chung YS
• Lee SH

• KMID: 2190892
• DOI: http://doi.org/10.3340/jkns.2013.54.3.159

Abstract

OBJECTIVE
Cerebral hyperperfusion syndrome (CHS) is a serious complication after carotid endarterectomy (CEA). However, the prevalence of CHS has decreased as techniques have improved. This study evaluates the role of strict blood pressure (BP) control for the prevention of CHS.
METHODS
All 18 patients who received CEA from February 2009 through November 2012 were retrospectively reviewed. All patients were routinely managed in an intensive care unit by a same protocol. The cerebral perfusion state was evaluated on the basis of the regional cerebral blood flow (rCBF) study by perfusion computed tomography (pCT) and mean velocity by transcranial doppler (TCD). BP was strictly controlled (<140/90 mm Hg) for 7 days. When either post-CEA hyperperfusion (>100% increase in the rCBF by pCT or in the mean velocity by TCD compared with preoperative values) or CHS was detected, BP was maintained below 120/80 mm Hg.
RESULTS
TCD and pCT data on the patients were analyzed. Ipsilateral rCBF was significantly increased after CEA in the pCT (p=0.049). Post-CEA hyperperfusion was observed in 3 patients (18.7%) in the pCT and 2 patients (12.5%) in the TCD study. No patients developed clinical CHS for one month after CEA. Furthermore, no patients developed additional neurological deficits related to postoperative cerebrovascular complications.
CONCLUSION
Intensive care with strict BP control (<140/90 mm Hg) achieved a low prevalence of post-CEA hyperperfusion and prevented CHS. This study suggests that intensive care with strict BP control can prevent the prevalence of post-CEA CHS.

Keyword

Carotid endarterectomy; Hyperperfusion; Cerebral blood flow; Blood pressure; Cerebral hyperperfusion syndrome

MeSH Terms

Blood Pressure*
Endarterectomy*
Endarterectomy, Carotid
Humans
Critical Care
Intensive Care Units
Perfusion
Prevalence
Retrospective Studies

Figure

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  Fig. 1 Algorithm for the treatment of patients after CEA. CEA : carotid endarterectomy, ICU : intensive care unit, BP : blood pressure, TCD : transcranial doppler, CHS : cerebral hyperperfusion syndrome, CT : computed tomography.

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  Fig. 2 Typical pattern of changes in Vmean after CEA by TCD. TCD shows the development of PHP in 2 patients (asterisks). CEA : carotid endarterectomy, TCD : transcranial doppler, PHP : post-CEA hyperperfusion.

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  Fig. 3 Comparison of preoperative and postoperative CBF status; mean CBF at the ipsilateral side increased by 54.8%. The CBF increase on the ipsilateral side to CEA is statistically significant (p=0.049). The CBF on the contralateral side also increased by 31.2% after CEA (p=0.221).*Statistically significant difference between preoperative and postoperative CBF. CBF : cerebral blood flow, CEA : carotid endarterectomy.

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