Prospective observation of neurological symptoms attributable to cerebral hyperfusion syndrome after CEA and CAS

Abstract

Introduction: Neurological symptoms are considered as most clinically significant symptoms with various pathogenesis, including cerebral hyperperfusion syndrome (CHS) and microembolism, in patients shortly after endarterectomy (CEA) and stenting (CAS) for internal carotid artery stenosis (ICA). Aim: This study aimed to compare the structure of neurological symptoms attributable to CHS after carotid artery revascularization collected retrospectively and prospectively in large patient cohorts. Material and methods: Prospective analysis included 1047 consecutive patients treated with CEA (n = 477) or CSA (n = 570) in a single centre from 2011 to 2015. In 2012 was introduced strict monitoring of pain in patients with headache and blood pressure (BP) and more intensive antihypertensive treatment in patients with an increase in BP post-procedure. The occurrence of neurological symptoms attributable to CHS was compared with a historical, retrospectively analysed less strictly monitored cohort (n = 1386). Results: Neurological symptoms attributed to CHS were observed less frequently in prospectively than retrospectively analysed cohort: 8.3% vs 10.6% (p = 0.03) of CEA and 5.7% vs 8.0% (p = 0.10) of CAS group, respectively. The profile of neurological symptoms was similar in both cohorts. The prospective analysis revealed more episodes of transient bradycardia and/or hypotension in the CAS group (10.4 vs 8.8% and 11.2 vs 9.2%, respectively). Conclusion: The incidence of neurological symptoms attributable to cerebral hyperperfusion syndrome after carotid artery revascularization in short-term observation is similar regardless of the method used. Strict monitoring of BP slightly decreased the prevalence of neurological symptoms after carotid artery revascularization.