Hyperperfusion syndrome after carotid endarterectomy
Hyperperfusion syndrome after carotid endarterectomy (CEA) or carotid artery stenting (CAS) is a rare complication.
Hyperperfusion occurs in ~7.5% (range 1-14%) of patients but only a minority (~1.5%) of patients are symptomatic 2,3, with incidence being reported slightly more after CEA (~2%) than after CAS (~1%) 4.
Patients present with a postoperative triad of 1,2:
- ipsilateral headache
- intracranial haemorrhage
Hypertension is also a common feature. Presentation is usually within the first week of surgery but has been reported up to a month after surgery 2.
The pathophysiological mechanism is unknown but thought to be secondary to increased cerebral blood flow (CBF) from a loss of cerebral autoregulation 2,3. Hyperperfusion is defined as CBF >100% above preoperative baseline but patients have been reported to be symptomatic with increases of 20-40% 2.
- 1. Karapanayiotides T, Meuli R, Devuyst G et-al. Postcarotid endarterectomy hyperperfusion or reperfusion syndrome. Stroke. 2004;36 (1): 21-6. doi:10.1161/01.STR.0000149946.86087.e5 - Pubmed citation
- 2. Adhiyaman V, Alexander S. Cerebral hyperperfusion syndrome following carotid endarterectomy. QJM. 2007;100 (4): 239-44. doi:10.1093/qjmed/hcm009 - Pubmed citation
- 3. Lieb M, Shah U, Hines GL. Cerebral hyperperfusion syndrome after carotid intervention: a review. Cardiol Rev. 2012;20 (2): 84-9. doi:10.1097/CRD.0b013e318237eef8 - Pubmed citation
- 4. Cho HJ, Kim YJ, Lee JH et-al. Post-carotid stenting reperfusion injury with blood-brain barrier disruption on gadolinium-enhanced FLAIR MRI. BMC Neurol. 2014;14 (1): 178. doi:10.1186/s12883-014-0178-z - Free text at pubmed - Pubmed citation