Abstract
Cerebral hyperperfusion syndrome is a serious complication of endovascular angioplasty and stent placement for long-standing intracranial stenosis, resulting in neurologic dysfunction, seizure, or reperfusion hemorrhage. Rigorous control of blood pressure is commonly used in the perioperative period to prevent cerebral hyperperfusion syndrome, but the optimal blood pressure is often arbitrary. We describe the angiographic features that reflect impaired cerebral autoregulation and microvascular transit abnormality, which may be used to gauge the optimal blood pressure parameters in the immediate postintervention period for prevention of cerebral hyperperfusion syndrome.
Highlights
ABBREVIATIONS: BP ϭ blood pressure; Cerebral hyperperfusion syndrome (CHS) ϭ cerebral hyperperfusion syndrome; ICAS ϭ intracranial atherosclerosis; intracerebral hemorrhage (ICH) ϭ intracranial hemorrhag
The present study describes sentinel angiographic signs of cerebral hyperperfusion following revascularization of patients with ICAS stenosis and how these markers are used in our practice in the imand a risk for hyperperfusion: first, an early draining vein of mediate postangioplasty phase to identify a BP threshold to avoid the treated ischemic territory, defined as early contrast filling of a CHS and its related complications
We surmise that the occurrence of an early draining vein angiogram that drains the territory downstream of the treated vessel; second, a prominent capillary blush in the ischemic territory, secondary to abnormal luxurious perfusion of the treated territory in the arterial phase, which becomes denser in the capillary phase compared with the rest of the arterial territory and persists late into the venous phase (Figure and On-line Figure)
Summary
ABBREVIATIONS: BP ϭ blood pressure; CHS ϭ cerebral hyperperfusion syndrome; ICAS ϭ intracranial atherosclerosis; ICH ϭ intracranial hemorrhag. Stringent systemic BP control is a widely used prophylactic strategy in the postrevascularization period and has been shown to reduce the incidence of CHS in high-risk individuals.[7,8] Ideally, quantitative cerebral blood flow should be monitored to guide the hemodynamic management, but continuous and reliable means of measurement are lacking in routine clinical practice.[4,5,8] This article illustrates the angiographic signs of hyperperfusion immediately after intracranial stent placement and angioplasty, and their utility in titrating individual BP targets in the postoperative period for the prevention of CHS.
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