Coutts Shelagh B, Hill Michael D, Hu William Y
Department of Clinical Neurosciences, University of Calgary, and Seaman Family MR Research Centre, Calgary, Alberta, Canada.
Neurosurgery. 2003 Nov;53(5):1053-58; discussion 1058-60. doi: 10.1227/01.neu.0000088738.80838.74.
Hyperperfusion syndrome is a rare and potentially devastating complication of carotid endarterectomy or carotid artery angioplasty and stenting. With the advent of new imaging techniques, we reviewed our experience with this phenomenon.
This report is a retrospective review of 129 consecutive cases of carotid endarterectomy performed between June 1, 2000, and May 31, 2002, and 44 consecutive cases of carotid artery angioplasty and stenting performed between January 1, 1997, and May 31, 2002. We specifically searched for examples of patients who developed postprocedural nonthrombotic neurological deficits that typified the hyperperfusion syndrome.
Seven cases of hyperperfusion syndrome occurred, four after endarterectomy (3.1% of carotid endarterectomy cases) and three after stenting (6.8% of stenting cases). The cases of hyperperfusion were classified as presenting with 1). acute focal edema (two cases with stroke-like presentation, attributable to edema immediately after revascularization), 2). acute hemorrhage (two cases of intracerebral hemorrhage immediately after stenting and one case immediately after endarterectomy), or 3). delayed classic presentation (two cases with seizures, focal motor weakness, and/or late intracerebral hemorrhage at least 24 hours after endarterectomy).
Hyperperfusion syndrome may be more common and more variable in clinical presentation than previously appreciated.
高灌注综合征是颈动脉内膜切除术或颈动脉血管成形术及支架置入术罕见但可能具有毁灭性的并发症。随着新成像技术的出现，我们回顾了我们在这一现象方面的经验。
本报告是对2000年6月1日至2002年5月31日期间连续进行的129例颈动脉内膜切除术以及1997年1月1日至2002年5月31日期间连续进行的44例颈动脉血管成形术及支架置入术的回顾性研究。我们专门寻找术后出现典型高灌注综合征的非血栓性神经功能缺损患者的病例。
发生了7例高灌注综合征，4例在颈动脉内膜切除术后（占颈动脉内膜切除术病例的3.1%），3例在支架置入术后（占支架置入术病例的6.8%）。高灌注病例分类如下：1）急性局灶性水肿（2例呈卒中样表现，归因于血运重建后立即出现的水肿），2）急性出血（2例在支架置入术后立即发生脑出血，1例在颈动脉内膜切除术后立即发生），或3）延迟典型表现（2例在颈动脉内膜切除术后至少24小时出现癫痫发作、局灶性运动无力和/或迟发性脑出血）。
高灌注综合征在临床表现上可能比以前认识到的更为常见且更具变异性。
