Hyperperfusion syndrome following carotid artery stenting:a case report and review of literatures / 介入放射学杂志

ABSTRACT

Objective Hyperperfusion syndrome is a rare and devastating complication of carotid artery angioplasty and stenting(CAS).We report the clinical character of this complication in a patient undergoing CAS.Methods This report is a retrospective review of one case with severe extracranial carotid stenosis of carotid angioplasty and stenting performed on March,2004.We analysesed the clinical and imagining character of this hyperperfusion syndrome related to CAS. Results The patient with subtotal occlusion of the right internal carotid artery had a 10-mm lesion treated percutaneously with implantation of 2 stents (Precise 6?30mm、10?40mm) under general anesthesia.The stenosis was postdilated with a 5?20mm balloon. Postprocedural angiography showed no significant stenosis, the blood pressure varied between 230～300/100～130mmHg,the heart rate decreased to 55/min. An urgent brain CT revealed extensive hemorrhage with 80ml in the right basal ganglia. Surgical evacuation was performed urgently under general anesthesia.After operation the patient presented with vegetative status.Conclusions Intracerebral hemorrhage is related to cerebral hyperperfusion after CAS.One of risk factors for hyperperfusion syndrome is of severe ipsilateral stenosis of 90% severity or greater with collateral carotid stenosis. Peri-and postintervention TCD monitoring is mandantory, TCD can be identified patients at risk of cerebral hyperperfusion,to decrease postintervention hemorrhage.