Hyperperfusion Syndrome After Carotid Endarterectomy: 5 Cases

Abstract

Scientific BACKGROUND: Hyperperfusion Syndrome (HS) is a rare but devastating complication which develops after carotid artery surgery or carotid artery stent placement. It is due to the breakdown of autoregulation mechanisms which have been adapted to chronically decreased blood flow.

Objectives, MATERIALS-METHODS: Five patients between 1987-2004 were diagnosed as HS after carotid endarterectomy (CEA). In this period, 320 CEA were done by the same surgical team. Risk and etiological factors, clinical signs, imaging studies and prognostic factors were evaluated.

RESULTS: Age of four male and five female patients was between 58-77 years. Four patients had two or more stroke risk factors, the most prominent of which was hypertension. Symptomatic internal carotid artery (ICA) stenosis was present in all patients. Four of them were evaluated because of transient ischemic attacks and another one because of stroke. Three of them had severe occlusive disease of the contralateral ICA. HS developed within 1-6 days postoperatively. The most frequent signs were headache, focal seizures and focal neurological deficits. Blood pressure (BP) was high in four of the patients in the postoperative period. ICAs were patent in all after surgery. Neuroimaging findings revealed intracerebral hemorrhage (ICH) in 3 patients. One patient’s ICH was associated with the use of anticoagulants. Two of them died. Recovery was within months in the other patient and within days in two non-hemorrhagic patients.

CONCLUSIONS: Detection of high risk patients and early diagnosis are important in the prevention of this devastating complication. Chronic hemispheric hypoperfusion, stroke, uncontrolled hypertension and anticoagulation increase the risk. Death and severe sequale can be prevented with the recognition of early clinical signs such as headache, close follow-up of BP and antihypertensive therapy.