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. 2022 Dec 6;8(4):207-214.
doi: 10.4103/bc.bc_43_22. eCollection 2022 Oct-Dec.

Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery

Georgios P Skandalakis  1   2 , Aristotelis Kalyvas  1   3 , Evgenia Lani  1   4 , Spyridon Komaitis  1   4 , Danai Manolakou  5 , Despoina Chatzopoulou  1 , Nikos Pantazis  6 , Georgios A Zenonos  7 , Constantinos G Hadjipanayis  2   7   8 , George Stranjalis  1   4 , Christos Koutsarnakis  1   4
Affiliations

Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery

Georgios P Skandalakis et al. Brain Circ. .

Abstract

Background: Cerebral hyperperfusion syndrome (CHS) following bypass surgery is a major cause of neurological morbidity and mortality. However, data regarding its prevention have not been assorted until date.

Objective: The objective of this study was to review the literature and evaluate whether any conclusion can be drawn regarding the effectiveness of any measure on preventing bypass-related CHS.

Methods: We systematically reviewed PubMed and Cochrane Library from September 2008 to September 2018 to collect data regarding the effectiveness of pharmacologic interventions on the refers to pretreatment (PRE) of bypass-related CHS. We categorized interventions regarding their class of drugs and their combinations and calculated overall pooled estimates of proportions of CHS development through random-effects meta-analysis of proportions.

Results: Our search yielded 649 studies, of which 23 fulfilled inclusion criteria. Meta-analysis included 23 studies/2,041 cases. In Group A (blood pressure [BP] control), 202 out of 1,174 pretreated cases developed CHS (23.3% pooled estimate; 95% confidence interval [CI]: 9.9-39.4), Group B (BP control + free radical scavenger [FRS]) 10/263 (0.3%; 95% CI: 0.0-14.1), Group C (BP control + antiplatelet) 22/204 (10.3%; 95% CI: 5.1-16.7), and Group D (BP control + postoperative sedation) 29/400 (6.8%; 95% CI: 4.4-9.6)].

Conclusions: BP control alone has not been proven effective in preventing CHS. However, BP control along with either a FRS or an antiplatelet agent or postoperative sedation seems to reduce the incidence of CHS.

Keywords: Bypass surgery; cerebral bypass; cerebral hyperperfusion syndrome; cerebral revascularization; hyperperfusion syndrome; intracranial bypass; reperfusion injury.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart schematically demonstrating the filtering procedure of the study selection process according to the PRISMA statement. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2
Forrest plots for a random-effects meta-analysis of the proportion of pretreated patients who developed CHS by type of study. (a) BP control, (b) BP control + free radical scavenger, (c) BP control + antiplatelet, (d) BP control + postoperative sedation. CHS: Cerebral hyperperfusion syndrome, CI: Confidence interval, ES: Effect size, BP: Blood pressure
Figure 3
Figure 3
Graph showing pooled estimates and 95% CIs of CHS incidence across different pretreatment groups. (A) BP control, (B) BP control + FRS, (C) BP control + antiplatelet, (D) BP control + postoperative sedation. CI: Confidence interval, CHS: Cerebral hyperperfusion syndrome, BP: Blood pressure, FRS: Free radical scavenger
See this image and copyright information in PMC

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