title: Post-carotid endarterectomy cerebral hyperperfusion syndrome : is it preventable by strict blood pressure control?
abstract: OBJECTIVE
  Cerebral hyperperfusion syndrome (CHS) is a serious complication after carotid endarterectomy (CEA). However, the prevalence of CHS has decreased as techniques have improved. This study evaluates the role of strict blood pressure (BP) control for the prevention of CHS.
  
  
  METHODS
  All 18 patients who received CEA from February 2009 through November 2012 were retrospectively reviewed. All patients were routinely managed in an intensive care unit by a same protocol. The cerebral perfusion state was evaluated on the basis of the regional cerebral blood flow (rCBF) study by perfusion computed tomography (pCT) and mean velocity by transcranial doppler (TCD). BP was strictly controlled (<140/90 mm Hg) for 7 days. When either post-CEA hyperperfusion (>100% increase in the rCBF by pCT or in the mean velocity by TCD compared with preoperative values) or CHS was detected, BP was maintained below 120/80 mm Hg.
  
  
  RESULTS
  TCD and pCT data on the patients were analyzed. Ipsilateral rCBF was significantly increased after CEA in the pCT (p=0.049). Post-CEA hyperperfusion was observed in 3 patients (18.7%) in the pCT and 2 patients (12.5%) in the TCD study. No patients developed clinical CHS for one month after CEA. Furthermore, no patients developed additional neurological deficits related to postoperative cerebrovascular complications.
  
  
  CONCLUSIONS
  Intensive care with strict BP control (<140/90 mm Hg) achieved a low prevalence of post-CEA hyperperfusion and prevented CHS. This study suggests that intensive care with strict BP control can prevent the prevalence of post-CEA CHS.
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
authors.forename: Kyung Hyun
authors.initials: KH
authors.lastname: Kim
authors.forename: Chang-Hyun
authors.initials: CH
authors.lastname: Lee
authors.forename: Young-Je
authors.initials: YJ
authors.lastname: Son
authors.forename: Hee-Jin
authors.initials: HJ
authors.lastname: Yang
authors.forename: Young Sub
authors.initials: YS
authors.lastname: Chung
authors.forename: Sang Hyung
authors.initials: SH
authors.lastname: Lee
keywords: Blood pressure; Carotid endarterectomy; Cerebral blood flow; Cerebral hyperperfusion syndrome; Hyperperfusion