Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients
Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients
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DOI：
10.3171/jns-07/12/1130
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发表时间：
2007-12-01
影响因子：
4.1
通讯作者：
Ogawa, Akira
中科院分区：
文献类型：
--
作者：
Ogasawara, Kuniaki;Sakai, Nobuyuki;Ogawa, Akira
Object.颈动脉内膜切除术（CEA）或颈动脉支架植入术（CAS）后脑过度灌注综合征（CHS）相关的颅内出血是一种罕见但潜在的破坏性并发症。在本研究中，作者评估了4494例接受CEA或CAS的颈动脉狭窄患者，以阐明CHS伴颅内出血患者的临床病理特征和结局。回顾性分析术后CHS患者的临床病理特征及预后。确定了61例CHS患者（1.4%），其中27例（0.6%）发生颅内出血。术后第6天发生CHS的高峰在那些谁经历了CEA和那些谁经历了CAS术后12小时内。Logistic回归分析结果显示，术后血压控制不良与CEA后CHS患者颅内出血的发生显著相关（p = 0.0164）。然而，请注意，没有一个测试变量与CAS后CHS患者颅内出血的发生显著相关。颅内出血患者的死亡率（p = 0.0010）和发病率（p = 0.0172）明显高于无颅内出血患者。CEA和CAS后的脑过度灌注综合征分别以延迟的经典和急性表现出现。虽然严格控制术后血压可以防止CEA后CHS患者颅内出血，但CAS后CHS患者的血压控制与颅内出血之间似乎没有关系。最后，伴有脑出血的CHS患者预后差。
Object. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome (CHS) following carotid endarterectomy (CEA) or carotid artery stenting (CAS) is a rare but potentially devastating complication. In the present study the authors evaluted 4494 patients with carotid artery stenosis who had undergone CEA or CAS to clarify the clinicopathological feature and outcomes of those with CHS and associated intracranial hemorrhage.Methods. Patients with postoperative CHS were retrospectively selected, and clinicopathological features and outcomes were studied.Results. Sixty-one patients with CHS (1.4%) were identified, and intracranial hemorrhage developed in 27 of them (0.6%). The onset of CHS peaked on the 6th postoperative day in those who had undergone CEA and within 12 hours in those who had undergone CAS. Results of logistic regression analysis demonstrated that poor postoperative control of blood pressure was significantly associated with the development of intracranial hemorrhage in patients with CHS after CEA (p = 0.0 164). Note, however, that none of the tested variables were significantly associated with the development of intracranial hemorrhage in patients with CHS after CAS. Mortality (p = 0.0010) and morbidity (p = 0.0172) rates were sianificantly higher in patients with intracranial hemorrhage than in those without.Conclusions. Cerebral hyperperfusion syndrome after CEA and CAS occurs with delayed classic and acute presentations, respectively. Although strict control of postoperative blood pressure prevents intracranial hemorrhage in patients with CHS after CEA, there appears to be no relationship between blood pressure control and intracranial hemorrhage in those with CHS after CAS. Finally, the prognosis of CHS in patients with associated intracerebral hemorrhage is poor.