Friday, June 25, 2021

Carotid endarterectomy hyperperfusion syndrome

Q: What is carotid endarterectomy hyperperfusion syndrome? 

 Answer: Immediately after repair of carotid stenosis, a patient may experience headache, and in some cases seizures, intracerebral hemorrhage (ICH), and/or cerebral edema. If not treated it may lead to death. 

Status-post Carotid Endarterectomy (CEA), there is an increase in cerebral blood flow. This is due to impaired cerebral auto-regulation. Hyperperfusion syndrome should be closely watched in patients who have prior high-grade i.e., > 80% stenosis, or may have a recent stroke. 

Patient usually complains of headaches at the ipsilateral side of the surgery. Headache improves with the upright position and optimization of the blood pressure.



1. 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. 

2. Pennekamp CW, Tromp SC, Ackerstaff RG, et al. Prediction of cerebral hyperperfusion after carotid endarterectomy with transcranial Doppler. Eur J Vasc Endovasc Surg 2012; 43:371.

3. W Tosh, M Patteril, Cerebral oximetry, BJA Education, Volume 16, Issue 12, December 2016, Pages 417–421,

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