Cerebral hyperperfusion syndrome after percutaneous transluminal stenting of the craniocervical arteries
Cerebral hyperperfusion syndrome after percutaneous transluminal stenting of the craniocervical arteries
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DOI：
10.1097/00006123-200008000-00013
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发表时间：
2000-08-01
期刊：
影响因子：
4.8
通讯作者：
Halbach, VV
中科院分区：
文献类型：
--
作者：
Meyers, PM;Higashida, RT;Halbach, VV
目的：脑过度灌注综合征是颈动脉内膜切除术的公认并发症，据报道其发生率为0.3%至1.2%。颅颈动脉血管内血运重建术后脑过度灌注的发生率尚不清楚。我们评价了血管内血运重建系列中脑过度灌注综合征的发生率。据我们所知，有没有以前的研究评估的发病率高灌注综合征后，经皮腔内血管成形术/stenting.METHODS：1996年3月至2000年2月，140例患者进行了经皮腔内血管成形术/stenting的颅颈动脉在我们的机构。在所有患者中，进行颈动脉和椎动脉的选择性双侧动脉造影，以记录颅颈动脉狭窄和侧支血流的部位以及血管内血运重建手术的结果。然后，我们回顾了所有相关的医疗记录，动脉造影片，和部分影像学研究，以确定脑灌注过度在这series.Results的发病率：7例（5.0%）开发的临床或放射学表现的脑灌注过度。在目标组中，经皮腔内支架植入术使颈动脉（n = 5）和椎动脉（n = 2）的狭窄病变（平均狭窄，91%）减少了90%至100%。所有7名患者在治疗后立即保持神经功能稳定。临床和影像学检查结果出现延迟，提示脑灌注过度。6例患者显示同侧半球水肿的证据，包括2例发生颅内出血（1例脑实质出血，1例脑实质出血和蛛网膜下腔出血）的患者，通过计算机断层扫描记录。4例患者的症状在72小时内消退，无出血。2例出血患者在较长时间内（范围，3 wk至6 mo）恢复。在84个月的累积随访期间（平均随访时间为12个月），没有长期后遗症或死亡。结论：高灌注综合征是颅外和颅内血管成形术和支架植入术的一种罕见但潜在的严重并发症。其临床表现与颈动脉内膜切除术后的高灌注综合征相似;然而，在通常接受血管内治疗的高危队列中，其患病率可能更高。我们的研究结果表明，应密切监测接受血管内支架植入术的患者是否存在过度灌注的证据，并仔细监测血压、心率和抗凝治疗。需要进一步的研究来证实脑过度灌注是这种情况的发病机制。
OBJECTIVE: Cerebral hyperperfusion syndrome is a recognized complication of carotid endarterectomy, with a reported incidence of 0.3 to 1.2%. The incidence of cerebral hyperperfusion after endovascular revascularization procedures of the craniocervical arteries remains unknown. We evaluated the incidence of cerebral hyperperfusion syndrome in our endovascular revascularization series. To our knowledge, there are no previous studies evaluating the incidence of hyperperfusion syndrome after percutaneous transluminal angioplasty/stenting.METHODS: Between March 1996 and February 2000, 140 patients underwent percutaneous transluminal angioplasty/stenting of the craniocervical arteries at our institution. In all patients, selective bilateral arteriography of the carotid and vertebral arteries was performed to document the sites of craniocervical stenosis and collateral blood flow and the results of the endovascular revascularization procedure. We then reviewed all pertinent medical records, arteriographic films, and sectional imaging studies to determine the incidence of cerebral hyperperfusion in this series.RESULTS: Seven patients (5.0%) developed clinical or radiological manifestations of cerebral hyperperfusion. In the target group, percutaneous transluminal stenting achieved a 90 to 100% reduction in stenotic lesions (mean stenosis, 91%) of the carotid (n = 5) and vertebral (n = 2) arteries. All seven patients remained neurologically stable immediately after treatment. There was delayed development of clinical and radiographic findings, suggestive of cerebral hyperperfusion. Six patients showed evidence of ipsilateral hemispheric edema, including two patients who developed intracranial hemorrhage (one parenchymal, one parenchymal and subarachnoid) documented by computed tomographic brain scans. Symptoms resolved within 72 hours in the four patients without hemorrhage. The two patients with hemorrhage recovered during a more protracted period (range, 3 wk to 6 mo). There were no long-term sequelae or deaths during a cumulative follow-up of 84 months (mean follow-up, 12 mo).CONCLUSION: Hyperperfusion syndrome is an uncommon but potentially serious complication of extracranial and intracranial angioplasty and stenting procedures. The clinical manifestations ave similar to hyperperfusion syndrome after carotid endarterectomy; however, the prevalence may be greater in the high-risk cohort commonly referred for endovascular treatment. Our findings suggest that patients undergoing endovascular stenting procedures should be closely monitored for evidence of hyperperfusion, with careful monitoring of blood pressure, heart rate, and anticoagulation. Further research is needed to confirm that cerebral hyperperfusion is the pathogenesis of this condition.