Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.
Eur J Vasc Endovasc Surg. 2018 Sep;56(3):322-333. doi: 10.1016/j.ejvs.2018.05.012. Epub 2018 Jun 29.
Cerebral hyperperfusion syndrome (CHS) is a preventable cause of stroke after carotid endarterectomy (CEA). There are currently no pooled data available on the incidence of CHS after carotid artery stenting (CAS). The aim of this review was to assess the relevance of CHS in the procedural stroke rate following CAS.
A systematic search on incidence rates of CHS after CAS was conducted in the MEDLINE, EMBASE, and Cochrane databases in November 2017. A meta-regression analysis was performed on CHS to explain heterogeneity and determine the impact of potential risk factors on observed CHS. The methodological quality of the included studies was assessed using the Cowley criteria.
The pooled CHS risk across 33 studies concerning 8731 CAS patients was 4.6% (3.1-6.8%). Stroke occurred in 47% of CHS patients, of which 54% were fatal or disabling. Average time from procedure to symptoms was 12 h (IQR 8-36 h). Impaired cerebrovascular reserve (CVR) was associated with a higher risk of CHS after CAS (RR 5.18; 95% CI 1.0-26.8; p = .049). Symptomatic status was associated with a lower risk of CHS (RR 0.20; 95% CI 0.07-0.59; p = .001).
CHS is a serious and frequent complication in patients undergoing carotid angioplasty with stenting, and is most likely to occur in the very early post-procedural period. Future studies are encouraged to investigate the effect of intensive haemodynamic monitoring, including blood pressure control and assessment of cerebral blood flow, on the incidence of stroke caused by CHS after CAS.
大脑高灌注综合征（CHS）是颈动脉内膜切除术（CEA）后卒中的可预防原因。目前尚无颈动脉支架置入术（CAS）后 CHS 发生率的汇总数据。本综述的目的是评估 CHS 在 CAS 后程序性卒中发生率中的相关性。
2017 年 11 月，在 MEDLINE、EMBASE 和 Cochrane 数据库中对 CAS 后 CHS 发生率的相关研究进行了系统检索。对 CHS 进行了荟萃回归分析，以解释异质性并确定潜在危险因素对观察到的 CHS 的影响。使用 Cowley 标准评估纳入研究的方法学质量。
33 项涉及 8731 例 CAS 患者的研究中，CHS 风险的汇总风险为 4.6%（3.1-6.8%）。CHS 患者中有 47%发生卒中，其中 54%为致死性或致残性。症状出现的平均时间为 12 小时（IQR 8-36 小时）。脑血管储备能力（CVR）受损与 CAS 后 CHS 的风险增加相关（RR 5.18；95%CI 1.0-26.8；p=0.049）。症状状态与 CHS 的风险降低相关（RR 0.20；95%CI 0.07-0.59；p=0.001）。
CHS 是接受颈动脉血管成形术加支架置入术的患者的一种严重且常见的并发症，最有可能在术后早期发生。鼓励未来的研究调查强化血流动力学监测，包括血压控制和脑血流评估，对 CAS 后由 CHS 引起的卒中发生率的影响。
