Hyperperfusion Syndrome: A Rare Complication of Carotid Artery Stenting

Abstract

Background: Hyperperfusion syndrome (HS) is a rare, but potentially devastating complication of carotid arter revascularization by either carotid endarterectomy (CEA) or carotid artery stenting (CAS). HS is believed to occur due to impaired autoregulation of cerebral blood flow. The typical clinical findings are ipsilateral throbbing headache, nausea, vomiting, focal deficits, and seizures developing mostly in the third and fifth days of revascularization. Objective: We describe a 72-year-old man with cerebral HS developing following CAS for high grade left ICA stenosis. He presented with generalized convulsion, focal neurological signs being heralded by ipsilateral headache developing 66 hours following the CAS procedure. Findings: lmaging studies showed ipsilateral hemispheric edema and focal parenchymal localized hemorrhage. With intensive pharmacological control of blood pressure and witholding antiplatelet agents, no progression ta intracranial hemorhage was observed. However, he expired 9 days after the stent procedure, probably as a result of pulmoner embolism. Conclusion: HS is an important clinical entity that must be considered in the differential diagnosis of embolic or hemorrhagic stroke after CAS. Careful screening ta identify the patients with high risk, postoperative monitoring for signs of HS, management of perioperative blood pressure are important steps in both preventing and minimizing this complication.