Hyperperfusion syndrome after carotid stent-supported angioplasty in patients with autonomic dysfunction

Abstract

Cerebral hyperperfusion syndrome (CHS) is a rare, serious complication of carotid revascularization either after carotid endarterectomy or carotid stent placement. Although extensive effort has been devoted to reducing the incidence of CHS, little is known about the prevention. Postprocedural hypertension is very rare due to autoregulation of carotid baroreceptors but may occur if presented with autonomic dysfunction. We present two cases of CHS after cerebral revascularization that presented autonomic dysfunction.

Keywords: Autonomic dysfunction; Carotid artery angioplasty; Cerebral hyperperfusion syndrome.

Fig. 1

A 78-year-old male patient's cerebral angiography and brain MRI. Conventional angiography before carotid artery stenting reveals severe stenosis of the right internal carotid artery (white arrow) (A). Successful angioplasty with stenting was done in the right internal carotid artery (black arrow) (B). On a 24-hour follow-up diffusion weighted MRI (C), newly developed restricted diffusion lesions in the right middle cerebral artery and anterior cerebral artery territory. The apparent diffusion coefficient in the lesions amounts to a much higher value than that of normal parenchymal tissue, suggesting vasogenic edema (D).

Fig. 2

A 75-year-old male patient's brain MRI and cerebral angiography. Diffusion weighted MRI before the intervention reveals a few tiny foci of infarcts in the left subcortical watershed distribution (A). Cerebral angiogram shows a critical stenosis at the left cervical ICA origin before (B) and after the intervention (C). The gradient echo sequence MRI after the intervention shows additionally blood in the left temporal lobes (D). ICA : internal carotid artery.