Document Detail


Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients.
MedLine Citation:
PMID:  18077950     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Intracranial hemorrhage associated with cerebral hyperperfusion syndrome (CHS) following carotid endarterectomy (CEA) or carotid artery stenting (CAS) is a rare but potentially devastating complication. In the present study the authors evaluated 4494 patients with carotid artery stenosis who had undergone CEA or CAS to clarify the clinicopathological features and outcomes of those with CHS and associated intracranial hemorrhage. METHODS: Patients with postoperative CHS were retrospectively selected, and clinicopathological features and outcomes were studied. RESULTS: Sixty-one patients with CHS (1.4%) were identified, and intracranial hemorrhage developed in 27 of them (0.6%). The onset of CHS peaked on the 6th postoperative day in those who had undergone CEA and within 12 hours in those who had undergone CAS. Results of logistic regression analysis demonstrated that poor postoperative control of blood pressure was significantly associated with the development of intracranial hemorrhage in patients with CHS after CEA (p = 0.0164). Note, however, that none of the tested variables were significantly associated with the development of intracranial hemorrhage in patients with CHS after CAS. Mortality (p = 0.0010) and morbidity (p = 0.0172) rates were significantly higher in patients with intracranial hemorrhage than in those without. CONCLUSIONS: Cerebral hyperperfusion syndrome after CEA and CAS occurs with delayed classic and acute presentations, respectively. Although strict control of postoperative blood pressure prevents intracranial hemorrhage in patients with CHS after CEA, there appears to be no relationship between blood pressure control and intracranial hemorrhage in those with CHS after CAS. Finally, the prognosis of CHS in patients with associated intracerebral hemorrhage is poor.
Authors:
Kuniaki Ogasawara; Nobuyuki Sakai; Terumasa Kuroiwa; Kohkichi Hosoda; Koji Iihara; Kazunori Toyoda; Chiaki Sakai; Izumi Nagata; Akira Ogawa;
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  107     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-12-14     Completed Date:  2008-01-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1130-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Neurosurgery, Iwate Medical University, Morioka, Japan. kuogasa@iwate-med.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Antihypertensive Agents / therapeutic use
Carotid Arteries*
Carotid Stenosis / therapy*
Cerebrovascular Disorders / etiology*
Endarterectomy, Carotid / adverse effects*
Female
Humans
Intracranial Hemorrhage, Hypertensive / etiology*,  mortality,  prevention & control
Male
Middle Aged
Postoperative Care
Prognosis
Retrospective Studies
Stents / adverse effects*
Time Factors
Chemical
Reg. No./Substance:
0/Antihypertensive Agents

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