Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting

Retrospective review of 4494 patients

Kuniaki Ogasawara, Nobuyuki Sakai, Terumasa Kuroiwa, Kohkichi Hosoda, Koji Iihara, Kazunori Toyoda, Chiaki Sakai, Izumi Nagata, Akira Ogawa, K. Akaji, K. Nakazawa, N. Hashimoto, H. Ooishi, H. Nagashima, T. Ichihashi, E. Kobayashi, M. Ezura, M. Hirohata, T. Hirayama, A. Nishio & 74 others S. Katoh, D. Sato, M. Kawanishi, H. Abe, K. Fukui, S. Iwabuchi, H. Ohta, N. Toma, W. Taki, T. Suyama, Y. Watanabe, S. Yamagata, N. Kitagawa, I. Nagata, A. Suzue, S. Matsubara, K. Satoh, S. Nagahiro, S. Tamatani, S. Yoshimura, K. Owada, A. Nishida, Kenji Sugiu, K. Iihara, T. Ueda, K. Haraguchi, Y. Matsumaru, H. Shimizu, T. Tsukahara, T. Hatano, T. Kawaguchi, S. Ota, N. Kuwayama, M. Kubo, M. Sonobe, Y. Kai, K. Tsumura, I. Naito, M. Komiyama, J. Ono, T. Machida, Y. Hori, T. Aoki, M. Nakamura, K. Hosoda, E. Kohmura, A. Hyodo, H. Yonaha, T. Imaoka, S. Kuroda, S. Terasaka, H. Yasuda, K. Takizawa, H. Kamiyama, K. Yamane, M. Tsuura, S. Miyachi, S. Munemoto, H. Manaka, I. Yamamoto, M. Mase, K. Yamada, Y. Watanabe, T. Higashi, I. Nakahara, Y. Kumon, K. Kazekawa, K. Uda, T. Inoue, M. Nakatsuka, H. Sakai, K. Hoya, M. Tanaka, N. Sakai

Research output: Contribution to journalArticle

192 Citations (Scopus)

Abstract

Object. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome (CHS) following carotid endarterectomy (CEA) or carotid artery stenting (CAS) is a rare but potentially devastating complication. In the present study the authors evaluated 4494 patients with carotid artery stenosis who had undergone CEA or CAS to clarify the clinicopathological features and outcomes of those with CHS and associated intracranial hemorrhage. Methods. Patients with postoperative CHS were retrospectively selected, and clinicopathological features and outcomes were studied. Results. Sixty-one patients with CHS (1.4%) were identified, and intracranial hemorrhage developed in 27 of them (0.6%). The onset of CHS peaked on the 6th postoperative day in those who had undergone CEA and within 12 hours in those who had undergone CAS. Results of logistic regression analysis demonstrated that poor postoperative control of blood pressure was significantly associated with the development of intracranial hemorrhage in patients with CHS after CEA (p = 0.0164). Note, however, that none of the tested variables were significantly associated with the development of intracranial hemorrhage in patients with CHS after CAS. Mortality (p = 0.0010) and morbidity (p = 0.0172) rates were significantly higher in patients with intracranial hemorrhage than in those without. Conclusions. Cerebral hyperperfusion syndrome after CEA and CAS occurs with delayed classic and acute presentations, respectively. Although strict control of postoperative blood pressure prevents intracranial hemorrhage in patients with CHS after CEA, there appears to be no relationship between blood pressure control and intracranial hemorrhage in those with CHS after CAS. Finally, the prognosis of CHS in patients with associated intracerebral hemorrhage is poor.

Original languageEnglish
Pages (from-to)1130-1136
Number of pages7
JournalJournal of Neurosurgery
Volume107
Issue number6
DOIs
Publication statusPublished - Dec 2007

Fingerprint

Carotid Endarterectomy
Intracranial Hemorrhages
Carotid Arteries
Blood Pressure
Carotid Stenosis
Cerebral Hemorrhage
Logistic Models
Regression Analysis
Morbidity

Keywords

  • Carotid artery stent
  • Carotid endarterectomy
  • Cerebral hyperperfusion syndrome
  • Intracranial hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting : Retrospective review of 4494 patients. / Ogasawara, Kuniaki; Sakai, Nobuyuki; Kuroiwa, Terumasa; Hosoda, Kohkichi; Iihara, Koji; Toyoda, Kazunori; Sakai, Chiaki; Nagata, Izumi; Ogawa, Akira; Akaji, K.; Nakazawa, K.; Hashimoto, N.; Ooishi, H.; Nagashima, H.; Ichihashi, T.; Kobayashi, E.; Ezura, M.; Hirohata, M.; Hirayama, T.; Nishio, A.; Katoh, S.; Sato, D.; Kawanishi, M.; Abe, H.; Fukui, K.; Iwabuchi, S.; Ohta, H.; Toma, N.; Taki, W.; Suyama, T.; Watanabe, Y.; Yamagata, S.; Kitagawa, N.; Nagata, I.; Suzue, A.; Matsubara, S.; Satoh, K.; Nagahiro, S.; Tamatani, S.; Yoshimura, S.; Owada, K.; Nishida, A.; Sugiu, Kenji; Iihara, K.; Ueda, T.; Haraguchi, K.; Matsumaru, Y.; Shimizu, H.; Tsukahara, T.; Hatano, T.; Kawaguchi, T.; Ota, S.; Kuwayama, N.; Kubo, M.; Sonobe, M.; Kai, Y.; Tsumura, K.; Naito, I.; Komiyama, M.; Ono, J.; Machida, T.; Hori, Y.; Aoki, T.; Nakamura, M.; Hosoda, K.; Kohmura, E.; Hyodo, A.; Yonaha, H.; Imaoka, T.; Kuroda, S.; Terasaka, S.; Yasuda, H.; Takizawa, K.; Kamiyama, H.; Yamane, K.; Tsuura, M.; Miyachi, S.; Munemoto, S.; Manaka, H.; Yamamoto, I.; Mase, M.; Yamada, K.; Watanabe, Y.; Higashi, T.; Nakahara, I.; Kumon, Y.; Kazekawa, K.; Uda, K.; Inoue, T.; Nakatsuka, M.; Sakai, H.; Hoya, K.; Tanaka, M.; Sakai, N.

In: Journal of Neurosurgery, Vol. 107, No. 6, 12.2007, p. 1130-1136.

Research output: Contribution to journalArticle

Ogasawara, K, Sakai, N, Kuroiwa, T, Hosoda, K, Iihara, K, Toyoda, K, Sakai, C, Nagata, I, Ogawa, A, Akaji, K, Nakazawa, K, Hashimoto, N, Ooishi, H, Nagashima, H, Ichihashi, T, Kobayashi, E, Ezura, M, Hirohata, M, Hirayama, T, Nishio, A, Katoh, S, Sato, D, Kawanishi, M, Abe, H, Fukui, K, Iwabuchi, S, Ohta, H, Toma, N, Taki, W, Suyama, T, Watanabe, Y, Yamagata, S, Kitagawa, N, Nagata, I, Suzue, A, Matsubara, S, Satoh, K, Nagahiro, S, Tamatani, S, Yoshimura, S, Owada, K, Nishida, A, Sugiu, K, Iihara, K, Ueda, T, Haraguchi, K, Matsumaru, Y, Shimizu, H, Tsukahara, T, Hatano, T, Kawaguchi, T, Ota, S, Kuwayama, N, Kubo, M, Sonobe, M, Kai, Y, Tsumura, K, Naito, I, Komiyama, M, Ono, J, Machida, T, Hori, Y, Aoki, T, Nakamura, M, Hosoda, K, Kohmura, E, Hyodo, A, Yonaha, H, Imaoka, T, Kuroda, S, Terasaka, S, Yasuda, H, Takizawa, K, Kamiyama, H, Yamane, K, Tsuura, M, Miyachi, S, Munemoto, S, Manaka, H, Yamamoto, I, Mase, M, Yamada, K, Watanabe, Y, Higashi, T, Nakahara, I, Kumon, Y, Kazekawa, K, Uda, K, Inoue, T, Nakatsuka, M, Sakai, H, Hoya, K, Tanaka, M & Sakai, N 2007, 'Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: Retrospective review of 4494 patients', Journal of Neurosurgery, vol. 107, no. 6, pp. 1130-1136. https://doi.org/10.3171/JNS-07/12/1130
Ogasawara, Kuniaki ; Sakai, Nobuyuki ; Kuroiwa, Terumasa ; Hosoda, Kohkichi ; Iihara, Koji ; Toyoda, Kazunori ; Sakai, Chiaki ; Nagata, Izumi ; Ogawa, Akira ; Akaji, K. ; Nakazawa, K. ; Hashimoto, N. ; Ooishi, H. ; Nagashima, H. ; Ichihashi, T. ; Kobayashi, E. ; Ezura, M. ; Hirohata, M. ; Hirayama, T. ; Nishio, A. ; Katoh, S. ; Sato, D. ; Kawanishi, M. ; Abe, H. ; Fukui, K. ; Iwabuchi, S. ; Ohta, H. ; Toma, N. ; Taki, W. ; Suyama, T. ; Watanabe, Y. ; Yamagata, S. ; Kitagawa, N. ; Nagata, I. ; Suzue, A. ; Matsubara, S. ; Satoh, K. ; Nagahiro, S. ; Tamatani, S. ; Yoshimura, S. ; Owada, K. ; Nishida, A. ; Sugiu, Kenji ; Iihara, K. ; Ueda, T. ; Haraguchi, K. ; Matsumaru, Y. ; Shimizu, H. ; Tsukahara, T. ; Hatano, T. ; Kawaguchi, T. ; Ota, S. ; Kuwayama, N. ; Kubo, M. ; Sonobe, M. ; Kai, Y. ; Tsumura, K. ; Naito, I. ; Komiyama, M. ; Ono, J. ; Machida, T. ; Hori, Y. ; Aoki, T. ; Nakamura, M. ; Hosoda, K. ; Kohmura, E. ; Hyodo, A. ; Yonaha, H. ; Imaoka, T. ; Kuroda, S. ; Terasaka, S. ; Yasuda, H. ; Takizawa, K. ; Kamiyama, H. ; Yamane, K. ; Tsuura, M. ; Miyachi, S. ; Munemoto, S. ; Manaka, H. ; Yamamoto, I. ; Mase, M. ; Yamada, K. ; Watanabe, Y. ; Higashi, T. ; Nakahara, I. ; Kumon, Y. ; Kazekawa, K. ; Uda, K. ; Inoue, T. ; Nakatsuka, M. ; Sakai, H. ; Hoya, K. ; Tanaka, M. ; Sakai, N. / Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting : Retrospective review of 4494 patients. In: Journal of Neurosurgery. 2007 ; Vol. 107, No. 6. pp. 1130-1136.
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title = "Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: Retrospective review of 4494 patients",
abstract = "Object. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome (CHS) following carotid endarterectomy (CEA) or carotid artery stenting (CAS) is a rare but potentially devastating complication. In the present study the authors evaluated 4494 patients with carotid artery stenosis who had undergone CEA or CAS to clarify the clinicopathological features and outcomes of those with CHS and associated intracranial hemorrhage. Methods. Patients with postoperative CHS were retrospectively selected, and clinicopathological features and outcomes were studied. Results. Sixty-one patients with CHS (1.4{\%}) were identified, and intracranial hemorrhage developed in 27 of them (0.6{\%}). The onset of CHS peaked on the 6th postoperative day in those who had undergone CEA and within 12 hours in those who had undergone CAS. Results of logistic regression analysis demonstrated that poor postoperative control of blood pressure was significantly associated with the development of intracranial hemorrhage in patients with CHS after CEA (p = 0.0164). Note, however, that none of the tested variables were significantly associated with the development of intracranial hemorrhage in patients with CHS after CAS. Mortality (p = 0.0010) and morbidity (p = 0.0172) rates were significantly higher in patients with intracranial hemorrhage than in those without. Conclusions. Cerebral hyperperfusion syndrome after CEA and CAS occurs with delayed classic and acute presentations, respectively. Although strict control of postoperative blood pressure prevents intracranial hemorrhage in patients with CHS after CEA, there appears to be no relationship between blood pressure control and intracranial hemorrhage in those with CHS after CAS. Finally, the prognosis of CHS in patients with associated intracerebral hemorrhage is poor.",
keywords = "Carotid artery stent, Carotid endarterectomy, Cerebral hyperperfusion syndrome, Intracranial hemorrhage",
author = "Kuniaki Ogasawara and Nobuyuki Sakai and Terumasa Kuroiwa and Kohkichi Hosoda and Koji Iihara and Kazunori Toyoda and Chiaki Sakai and Izumi Nagata and Akira Ogawa and K. Akaji and K. Nakazawa and N. Hashimoto and H. Ooishi and H. Nagashima and T. Ichihashi and E. Kobayashi and M. Ezura and M. Hirohata and T. Hirayama and A. Nishio and S. Katoh and D. Sato and M. Kawanishi and H. Abe and K. Fukui and S. Iwabuchi and H. Ohta and N. Toma and W. Taki and T. Suyama and Y. Watanabe and S. Yamagata and N. Kitagawa and I. Nagata and A. Suzue and S. Matsubara and K. Satoh and S. Nagahiro and S. Tamatani and S. Yoshimura and K. Owada and A. Nishida and Kenji Sugiu and K. Iihara and T. Ueda and K. Haraguchi and Y. Matsumaru and H. Shimizu and T. Tsukahara and T. Hatano and T. Kawaguchi and S. Ota and N. Kuwayama and M. Kubo and M. Sonobe and Y. Kai and K. Tsumura and I. Naito and M. Komiyama and J. Ono and T. Machida and Y. Hori and T. Aoki and M. Nakamura and K. Hosoda and E. Kohmura and A. Hyodo and H. Yonaha and T. Imaoka and S. Kuroda and S. Terasaka and H. Yasuda and K. Takizawa and H. Kamiyama and K. Yamane and M. Tsuura and S. Miyachi and S. Munemoto and H. Manaka and I. Yamamoto and M. Mase and K. Yamada and Y. Watanabe and T. Higashi and I. Nakahara and Y. Kumon and K. Kazekawa and K. Uda and T. Inoue and M. Nakatsuka and H. Sakai and K. Hoya and M. Tanaka and N. Sakai",
year = "2007",
month = "12",
doi = "10.3171/JNS-07/12/1130",
language = "English",
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pages = "1130--1136",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
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TY - JOUR

T1 - Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting

T2 - Retrospective review of 4494 patients

AU - Ogasawara, Kuniaki

AU - Sakai, Nobuyuki

AU - Kuroiwa, Terumasa

AU - Hosoda, Kohkichi

AU - Iihara, Koji

AU - Toyoda, Kazunori

AU - Sakai, Chiaki

AU - Nagata, Izumi

AU - Ogawa, Akira

AU - Akaji, K.

AU - Nakazawa, K.

AU - Hashimoto, N.

AU - Ooishi, H.

AU - Nagashima, H.

AU - Ichihashi, T.

AU - Kobayashi, E.

AU - Ezura, M.

AU - Hirohata, M.

AU - Hirayama, T.

AU - Nishio, A.

AU - Katoh, S.

AU - Sato, D.

AU - Kawanishi, M.

AU - Abe, H.

AU - Fukui, K.

AU - Iwabuchi, S.

AU - Ohta, H.

AU - Toma, N.

AU - Taki, W.

AU - Suyama, T.

AU - Watanabe, Y.

AU - Yamagata, S.

AU - Kitagawa, N.

AU - Nagata, I.

AU - Suzue, A.

AU - Matsubara, S.

AU - Satoh, K.

AU - Nagahiro, S.

AU - Tamatani, S.

AU - Yoshimura, S.

AU - Owada, K.

AU - Nishida, A.

AU - Sugiu, Kenji

AU - Iihara, K.

AU - Ueda, T.

AU - Haraguchi, K.

AU - Matsumaru, Y.

AU - Shimizu, H.

AU - Tsukahara, T.

AU - Hatano, T.

AU - Kawaguchi, T.

AU - Ota, S.

AU - Kuwayama, N.

AU - Kubo, M.

AU - Sonobe, M.

AU - Kai, Y.

AU - Tsumura, K.

AU - Naito, I.

AU - Komiyama, M.

AU - Ono, J.

AU - Machida, T.

AU - Hori, Y.

AU - Aoki, T.

AU - Nakamura, M.

AU - Hosoda, K.

AU - Kohmura, E.

AU - Hyodo, A.

AU - Yonaha, H.

AU - Imaoka, T.

AU - Kuroda, S.

AU - Terasaka, S.

AU - Yasuda, H.

AU - Takizawa, K.

AU - Kamiyama, H.

AU - Yamane, K.

AU - Tsuura, M.

AU - Miyachi, S.

AU - Munemoto, S.

AU - Manaka, H.

AU - Yamamoto, I.

AU - Mase, M.

AU - Yamada, K.

AU - Watanabe, Y.

AU - Higashi, T.

AU - Nakahara, I.

AU - Kumon, Y.

AU - Kazekawa, K.

AU - Uda, K.

AU - Inoue, T.

AU - Nakatsuka, M.

AU - Sakai, H.

AU - Hoya, K.

AU - Tanaka, M.

AU - Sakai, N.

PY - 2007/12

Y1 - 2007/12

N2 - Object. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome (CHS) following carotid endarterectomy (CEA) or carotid artery stenting (CAS) is a rare but potentially devastating complication. In the present study the authors evaluated 4494 patients with carotid artery stenosis who had undergone CEA or CAS to clarify the clinicopathological features and outcomes of those with CHS and associated intracranial hemorrhage. Methods. Patients with postoperative CHS were retrospectively selected, and clinicopathological features and outcomes were studied. Results. Sixty-one patients with CHS (1.4%) were identified, and intracranial hemorrhage developed in 27 of them (0.6%). The onset of CHS peaked on the 6th postoperative day in those who had undergone CEA and within 12 hours in those who had undergone CAS. Results of logistic regression analysis demonstrated that poor postoperative control of blood pressure was significantly associated with the development of intracranial hemorrhage in patients with CHS after CEA (p = 0.0164). Note, however, that none of the tested variables were significantly associated with the development of intracranial hemorrhage in patients with CHS after CAS. Mortality (p = 0.0010) and morbidity (p = 0.0172) rates were significantly higher in patients with intracranial hemorrhage than in those without. Conclusions. Cerebral hyperperfusion syndrome after CEA and CAS occurs with delayed classic and acute presentations, respectively. Although strict control of postoperative blood pressure prevents intracranial hemorrhage in patients with CHS after CEA, there appears to be no relationship between blood pressure control and intracranial hemorrhage in those with CHS after CAS. Finally, the prognosis of CHS in patients with associated intracerebral hemorrhage is poor.

AB - Object. Intracranial hemorrhage associated with cerebral hyperperfusion syndrome (CHS) following carotid endarterectomy (CEA) or carotid artery stenting (CAS) is a rare but potentially devastating complication. In the present study the authors evaluated 4494 patients with carotid artery stenosis who had undergone CEA or CAS to clarify the clinicopathological features and outcomes of those with CHS and associated intracranial hemorrhage. Methods. Patients with postoperative CHS were retrospectively selected, and clinicopathological features and outcomes were studied. Results. Sixty-one patients with CHS (1.4%) were identified, and intracranial hemorrhage developed in 27 of them (0.6%). The onset of CHS peaked on the 6th postoperative day in those who had undergone CEA and within 12 hours in those who had undergone CAS. Results of logistic regression analysis demonstrated that poor postoperative control of blood pressure was significantly associated with the development of intracranial hemorrhage in patients with CHS after CEA (p = 0.0164). Note, however, that none of the tested variables were significantly associated with the development of intracranial hemorrhage in patients with CHS after CAS. Mortality (p = 0.0010) and morbidity (p = 0.0172) rates were significantly higher in patients with intracranial hemorrhage than in those without. Conclusions. Cerebral hyperperfusion syndrome after CEA and CAS occurs with delayed classic and acute presentations, respectively. Although strict control of postoperative blood pressure prevents intracranial hemorrhage in patients with CHS after CEA, there appears to be no relationship between blood pressure control and intracranial hemorrhage in those with CHS after CAS. Finally, the prognosis of CHS in patients with associated intracerebral hemorrhage is poor.

KW - Carotid artery stent

KW - Carotid endarterectomy

KW - Cerebral hyperperfusion syndrome

KW - Intracranial hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=37149008133&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=37149008133&partnerID=8YFLogxK

U2 - 10.3171/JNS-07/12/1130

DO - 10.3171/JNS-07/12/1130

M3 - Article

VL - 107

SP - 1130

EP - 1136

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 6

ER -