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.

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References:

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, https://doi.org/10.1093/bjaed/mkw024