Hashimoto Tetsuya, Matsumoto Shoji, Ando Mitsushige, Chihara Hideo, Tsujimoto Atsushi, Hatano Taketo
Department of Neurology, Stroke Center, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Fukuoka, Japan.
Department of Neurology, Stroke Center, Kokura Memorial Hospital, Kokurakita-ku, Kitakyushu, Fukuoka, Japan.
World Neurosurg. 2018 Feb;110:145-151. doi: 10.1016/j.wneu.2017.11.023. Epub 2017 Nov 14.
Cerebral hyperperfusion syndrome (CHS) is known to be a rare but devastating complication of carotid artery revascularization. Because patients with acute ischemic stroke due to acute major cerebral and/or cervical artery occlusion treated with endovascular reperfusion therapy may have impaired autoregulation in the cerebral vasculature, these patients may also develop CHS. Despite the growing number of endovascular reperfusion procedures for acute ischemic stroke, this complication has only rarely been reported.
A 77-year-old man developed acute cerebral infarction as the result of occlusions of the right internal carotid artery and right middle cerebral artery. After systemic intravenous injection of recombinant tissue-type plasminogen activator, endovascular reperfusion therapy was initiated. The occluded arteries were successfully recanalized with thrombectomy by using a stent retriever for the middle cerebral artery and stent placement for the origin of the internal carotid artery. However, head computed tomography obtained 12 hours after treatment showed acute intracranial hemorrhage that did not involve the ischemic lesions. Under evaluation with transcranial near-infrared spectroscopy and single-photon emission computed tomography, the hemorrhage was considered to have been caused by CHS after reperfusion therapy.
CHS may lead to unfavorable outcomes after reperfusion therapy for acute ischemic stroke. Recognizing clinical deterioration caused by CHS can be challenging in patients with neurologic disorders of acute ischemic stroke. Therefore, it is important to perform routine monitoring of regional cerebral oxygen saturation by using near-infrared spectroscopy, perform single-photon emission computed tomography promptly to evaluate cerebral blood flow, and maintain strict antihypertensive therapy to prevent CHS after reperfusion therapy.
脑过度灌注综合征（CHS）是颈动脉血运重建术后一种罕见但具有破坏性的并发症。由于接受血管内再灌注治疗的急性大脑和/或颈总动脉闭塞所致急性缺血性卒中患者的脑血管自动调节功能可能受损，这些患者也可能发生CHS。尽管急性缺血性卒中的血管内再灌注手术数量不断增加，但这种并发症仅有极少的报道。
一名77岁男性因右侧颈内动脉和右侧大脑中动脉闭塞而发生急性脑梗死。在全身静脉注射重组组织型纤溶酶原激活剂后，开始进行血管内再灌注治疗。通过使用大脑中动脉的支架取栓器和颈内动脉起始部的支架置入术，成功使闭塞动脉再通。然而，治疗后12小时的头部计算机断层扫描显示急性颅内出血，未累及缺血性病变。经颅近红外光谱和单光子发射计算机断层扫描评估后，认为出血是再灌注治疗后CHS所致。
CHS可能导致急性缺血性卒中再灌注治疗后出现不良结局。对于急性缺血性卒中伴有神经功能障碍的患者，识别由CHS引起的临床恶化可能具有挑战性。因此，重要的是通过近红外光谱对局部脑氧饱和度进行常规监测，及时进行单光子发射计算机断层扫描以评估脑血流量，并维持严格的降压治疗以预防再灌注治疗后的CHS。
