Cerebral Hyperperfusion Syndrome Following Carotid Artery Revascularization

Mechanism: arteries may become unable to autoregulate arterial blood flow in areas of chronic hypoperfusion

Types of carotid revascularization procedures associated with hyperperfusion:

(1) endarterectomy

(2) stent placement

Risk factors:

(1) severe and/or bilateral carotid artery stenosis

(2) previous stroke

(3) periprocedural hypertension

(4) poor collateral blood supply

Features of hyperperfusion:

(1) increased cerebral blood flow (increase > 100% over baseline)

(2) signs and symptoms ipsilateral to the treated artery including headache, eye or facial pain, vomiting, seizures, decreased level of consciousness or a focal neurological deficit

(3) exclusion of thromboembolism or stroke

Complications:

(1) bleeding with intracerebral or subarachnoid hemorrhage

(2) cerebral edema