Hyperfusion syndrome after CEA

Q: Why it is important to have a tight blood pressure control after carotid endarterectomy (CEA)?


Answer: Hypertension is a predecessor of the hyperfusion syndrome after CEA. Though it is not a common sequela of post CEA, but it can be devastating causing intracerebral hemorrhage (ICH) and seizures. It mostly occurs in first 2 weeks of the procedure. This is due to the restoration of blood flow within the previously hypoperfused cerebral hemisphere, where vessels may have lost the capacity to autoregulate. Peri and post operative BP control can prevent that. Risk factors are high-grade stenosis, carotid lesion, and  recent stroke. Clinical sign is ipsilateral headache to the revascularized side which improves at upright posture. Other clinical signs are focal motor seizures, and postictal Todd's paralysis. 


References: 

1.  Coutts SB, Hill MD, Hu WY. Hyperperfusion syndrome: toward a stricter definition. Neurosurgery 2003; 53:1053. 

2. Bouri S, Thapar A, Shalhoub J, et al. Hypertension and the post-carotid endarterectomy cerebral hyperperfusion syndrome. Eur J Vasc Endovasc Surg 2011; 41:229. 

3. Piepgras DG, Morgan MK, Sundt TM Jr, et al. Intracerebral hemorrhage after carotid endarterectomy. J Neurosurg 1988; 68:532. 

4. Karapanayiotides T, Meuli R, Devuyst G, et al. Postcarotid endarterectomy hyperperfusion or reperfusion syndrome. Stroke 2005; 36:21.