title: Can the diameter of endoluminal shunt influence the risk of hyperperfusion syndrome after carotid endarterectomy?
abstract: OBJECTIVE
  The aim of this study was to evaluate if there is a possible relation between the size of endoluminal shunt, in carotid endarterectomy (CEA), and the risk of postoperative hyperperfusion syndrome.
  
  
  METHODS
  We retrospectively studied prospectively collected data from 156 patients, who were subjected to CEA using shunting and vein patch angioplasty. One hundred and thirty-eight of the patients had bilateral, high grade (> or = 90%) internal carotid lesions and the remaining 18 had a high-grade stenosis (> or = 90%) and a contralateral internal carotid artery (ICA) occlusion. In 81 patients varying diameters of shunts were used (8-14 Fr) according to the diameter of ICA (group A) and in the other 75 patients (group B) only the smallest shunt was used (8 Fr). Development of hyperperfusion syndrome was evaluated both clinically and radiologically with magnetic resonance imaging.
  
  
  RESULTS
  Fifteen patients developed hyperperfusion syndrome (9.6%), between 0 to 6 days postoperatively. Thirteen belonged to group A (86.6%), and 2 (13.3%) belonged to group B (P<0.05). One had an intracerebral hemorrhage (0.6% of the study group) the 3rd postsurgical day.
  
  
  CONCLUSIONS
  During CEA in patients with high-grade bilateral lesions, we recommend the use of a shunt with small diameter: this aims at reducing the risk of hyperperfusion syndrome.
authors.affiliation: First Department of Surgery, Vascular Department, University of Athens Medical School, Laiko General Hospital, Athens, Greece. bakogian@hotmail.com
authors.forename: C N
authors.initials: CN
authors.lastname: Bakoyiannis
authors.forename: N
authors.initials: N
authors.lastname: Tsekouras
authors.forename: S
authors.initials: S
authors.lastname: Georgopoulos
authors.forename: C
authors.initials: C
authors.lastname: Tsigris
authors.forename: K
authors.initials: K
authors.lastname: Filis
authors.forename: I
authors.initials: I
authors.lastname: Skrapari
authors.forename: E
authors.initials: E
authors.lastname: Bastounis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D002343:Carotid Artery, Internal / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome