Hyperperfusion syndrome: toward a stricter definition.
OBJECTIVE
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
Hyperperfusion syndrome may be more common and more variable in clinical presentation than previously appreciated.
Coutts
Shelagh B
SB
Department of Clinical Neurosciences, University of Calgary, and Seaman Family MR Research Centre, Calgary, Alberta, Canada. shelagh.coutts@calgaryhealthregion.ca
Hill
Michael D
MD
Hu
William Y
WY
D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D013577:Syndrome