Skip to main content

Advertisement

SpringerLink
Log in

Hyperperfusion syndrome after carotid stent angioplasty

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

This study assesses the incidence and causes of hyperperfusion syndrome occurring after carotid artery stenting (CAS).

Materials and methods

We retrospectively reviewed the clinical database of 417 consecutive patients who were treated with CAS in our department to identify patients who developed hyperperfusion syndrome and/or intracranial hemorrhage. Magnetic resonance imaging (MRI) including fluid-attenuated inversion recovery and diffusion-weighted imaging was performed before and after CAS in 269 cases. A Spearman’s rho nonparametric correlation was performed to determine whether there was a correlation between the occurrence/development of hyperperfusion syndrome and the patient’s age, degree of stenosis on the stented and contralateral side, risk factors such as diabetes, smoking, hypertension, adiposity, gender and fluoroscopy time, and mean area of postprocedural lesions as well as preexisting lesions. Significance was established at p < 0.05.

Results

Of the 417 carotid arteries stented and where MRI was also completed, we found hyperperfusion syndrome in 2.4% (ten cases). Patients who had preexisting brain lesions (previous or acute stroke) were at a higher risk of developing hyperperfusion syndrome (p = 0.022; Spearman’s rho test). We could not validate any correlation with the other patient characteristics.

Conclusion

Extensive microvascular disease may be a predictor of hyperperfusion syndrome after carotid stent placement. We believe that further studies are warranted to predict more accurately which patients are at greater risk of developing this often fatal complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Fiehler J, Jansen O, Berger J, Eckstein HH, Ringleb PA, Stingele R (2008) Differences in complication rates among the centres in the SPACE study. Neuroradiology 50:1049–1053 doi:10.1007/s00234-008-0459-6

    Article  PubMed  Google Scholar 

  2. Sundt TM Jr, Sharbrough FW, Piepgras DG, Kearns TP, Messick JM Jr, O’Fallon WM (1981) Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral ischemia. Mayo Clin Proc 56:533–543

    PubMed  Google Scholar 

  3. Krajickova D, Krajina A, Nova M, Raupach J (2005) Fatal intraventricular hemorrhage after the extracranial carotid artery angioplasty and stent placement. Cardiovasc Intervent Radiol 28:502–505 doi:10.1007/s00270-004-0155-9

    Article  PubMed  Google Scholar 

  4. McCabe DJ, Brown MM, Clifton A (1999) Fatal cerebral reperfusion hemorrhage after carotid stenting. Stroke 30:2483–2486

    PubMed  CAS  Google Scholar 

  5. Gurm HS, Nallamothu BK, Yadav J (2008) Safety of carotid artery stenting for symptomatic carotid artery disease: a meta-analysis. Eur Heart J 29:113–119 doi:10.1093/eurheartj/ehm362

    Article  PubMed  Google Scholar 

  6. Coutts SB, Hill MD, Hu WY (2003) Hyperperfusion syndrome: toward a stricter definition. Neurosurgery 53:1053–1058, discussion 1058–1060 doi:10.1227/01.NEU.0000088738.80838.74

    Article  PubMed  Google Scholar 

  7. Karapanayiotides T, Meuli R, Devuyst G et al (2005) Postcarotid endarterectomy hyperperfusion or reperfusion syndrome. Stroke 36:21–26 doi:10.1161/01.STR.0000149946.86087.e5

    Article  PubMed  Google Scholar 

  8. Kieburtz K, Ricotta JJ, Moxley RT 3rd (1990) Seizures following carotid endarterectomy. Arch Neurol 47:568–570

    PubMed  CAS  Google Scholar 

  9. Piepgras DG, Morgan MK, Sundt TM Jr, Yanagihara T, Mussman LM (1988) Intracerebral hemorrhage after carotid endarterectomy. J Neurosurg 68:532–536

    PubMed  CAS  Google Scholar 

  10. Solomon RA, Loftus CM, Quest DO, Correll JW (1986) Incidence and etiology of intracerebral hemorrhage following carotid endarterectomy. J Neurosurg 64:29–34

    Article  PubMed  CAS  Google Scholar 

  11. Kaku Y, Yoshimura S, Kokuzawa J (2004) Factors predictive of cerebral hyperperfusion after carotid angioplasty and stent placement. AJNR Am J Neuroradiol 25:1403–1408

    PubMed  Google Scholar 

  12. Meyers PM, Phatouros CC, Higashida RT (2006) Hyperperfusion syndrome after intracranial angioplasty and stent placement. Stroke 37:2210–2211 doi:10.1161/01.STR.0000237208.77716.1c

    Article  PubMed  Google Scholar 

  13. Morrish W, Grahovac S, Douen A et al (2000) Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis. AJNR Am J Neuroradiol 21:1911–1916

    PubMed  CAS  Google Scholar 

  14. Schoser BG, Heesen C, Eckert B, Thie A (1997) Cerebral hyperperfusion injury after percutaneous transluminal angioplasty of extracranial arteries. J Neurol 244:101–104 doi:10.1007/s004150050057

    Article  PubMed  CAS  Google Scholar 

  15. Yadav JS, Roubin GS, Iyer S et al (1997) Elective stenting of the extracranial carotid arteries. Circulation 95:376–381

    PubMed  CAS  Google Scholar 

  16. North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453

    Google Scholar 

  17. Ogasawara K, Sakai N, Kuroiwa T et al (2007) Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients. J Neurosurg 107:1130–1136 doi:10.3171/JNS-07/12/1130

    Article  PubMed  Google Scholar 

  18. Kadkhodayan Y, Cross DT 3rd, Derdeyn CP, Moran CJ (2007) Carotid angioplasty and stenting in the elderly. Neuroradiology 49:933–938 doi:10.1007/s00234-007-0278-1

    Article  PubMed  Google Scholar 

  19. Chamorro A, Vila N, Obach V, Macho J, Blasco J (2000) A case of cerebral hemorrhage early after carotid stenting. Stroke 31:792–793

    PubMed  CAS  Google Scholar 

  20. Lovblad KO, Bassetti C, Schneider J, Ozdoba C, Remonda L, Schroth G (2000) Diffusion-weighted MRI suggests the coexistence of cytotoxic and vasogenic oedema in a case of deep cerebral venous thrombosis. Neuroradiology 42:728–731 doi:10.1007/s002340000395

    Article  PubMed  CAS  Google Scholar 

  21. Lovblad KO, Pluschke W, Remonda L et al (2000) Diffusion-weighted MRI for monitoring neurovascular interventions. Neuroradiology 42:134–138 doi:10.1007/s002340050032

    Article  PubMed  CAS  Google Scholar 

  22. Reigel MM, Hollier LH, Sundt TM Jr, Piepgras DG, Sharbrough FW, Cherry KJ (1987) Cerebral hyperperfusion syndrome: a cause of neurologic dysfunction after carotid endarterectomy. J Vasc Surg 5:628–634 doi:10.1067/mva.1987.avs0050628

    Article  PubMed  CAS  Google Scholar 

  23. Sfyroeras GS, Karkos CD, Gerassimidis TS (2008) Cerebral perfusion patterns in patients with extracranial carotid atherosclerosis and the impact of carotid stenting. A review. J Cardiovasc Surg (Torino) 49:497–502

    CAS  Google Scholar 

  24. Zahn R, Ischinger T, Hochadel M et al (2007) Carotid artery stenting in octogenarians: results from the ALKK Carotid Artery Stent (CAS) Registry. Eur Heart J 28:370–375 doi:10.1093/eurheartj/ehl421

    Article  PubMed  Google Scholar 

  25. Abou-Chebl A, Reginelli J, Bajzer CT, Yadav JS (2007) Intensive treatment of hypertension decreases the risk of hyperperfusion and intracerebral hemorrhage following carotid artery stenting. Catheter Cardiovasc Interv 69:690–696 doi:10.1002/ccd.20693

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department for Interventional and Diagnostic Neuroradiology, University of the Saarland, 66424, Homburg, Germany

    I. Q. Grunwald, M. Politi, W. Reith, C. Krick, K. Karp, A. Zimmer, T. Struffert, A. L. Kühn & P. Papanagiotou

  2. Clinic for Neurology, University of the Saarland, Homburg, Germany

    C. Roth & A. Haass

Authors
  1. I. Q. Grunwald
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Politi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Reith
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Krick
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Karp
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Zimmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. T. Struffert
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. Roth
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. L. Kühn
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A. Haass
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. P. Papanagiotou
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Q. Grunwald.

Additional information

I. Q. Grunwald and M. Politi contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Grunwald, I.Q., Politi, M., Reith, W. et al. Hyperperfusion syndrome after carotid stent angioplasty. Neuroradiology 51, 169–174 (2009). https://doi.org/10.1007/s00234-008-0483-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-008-0483-6

Keywords

Search

Navigation