Abstract 3088: A Systematic Study of Cerebral Hyperperfusion Syndrome after Carotid Endarterectomy
Background: Cerebral hyperperfusion syndrome (CHS) is a well documented complication of carotid endarterecomy (CEA), yet prior research has been limited to small case series and retrospective analyses, or studies using radiographic rather than clinical definitions.
Methods: A prospective, independent monitoring system was implemented to monitor CEA outcomes at a major academic medical center. Independent, trained monitors from the neurology department examined all patients undergoing CEA both preoperatively and postoperatively at 24 hours and 30 days. Data were collected on patient demographics, medical history, and procedural and anatomical variables. Clinical variables were analyzed to identify risk factors for CHS, which was defined as cases with postoperative development of a severe headache, new neurological deficits without infarction, seizure or intracerebral hemorrhage.
Results: Between 2008 and 2010, 832 CEA were monitored and CHS occurred in 14 (1.7%), including seizures in 5 (0.6%) subjects and intracerebral hemorrhage in 4 (0.5%). Univariate analysis identified a history of dyslipidemia, degree of ipsilateral stenosis and urgent CEA (performed during hospitalization for a symptomatic ipsilateral stroke, TIA or amaurosis fugax) as potential risks for CHS (all p<0.2), whereas age, sex, race, hypertension, diabetes, smoking, degree of contralateral stenosis, operative time, presence of intraoperative EEG slowing, history of prior CEA or carotid stent and time from prior carotid interventions were not significant. Multivariable analysis confirmed the risk association between urgent CEA and CHS (p=0.015) but not dyslipidemia (p=0.084) or degree of ipsilateral stenosis (p=0.118). Surgical indications in urgent CEA patients who developed CHS were amaurosis fugax (1), TIA (3) and stroke (5).
Conclusions: Independent, prospective monitoring of a large cohort of CEA cases identified a brief time interval between ischemic symptoms and endarterectomy as the clearest risk factor for CHS, with dyslipidemia and a high degree of ipsilateral carotid stenosis as possible contributory risks. Occurrence of CHS in patients undergoing urgent CEA does not appear to be limited to those with large strokes.
- © 2012 by American Heart Association, Inc.