Early Recognition of Cerebral Hyperperfusion syndrome after Carotid Stenting - a Case Report

僅管施行頸動脈支架術的病患數不斷增加，然而在這些接受頸動脈支架放置病例中，腦部過度灌流症候群是一很少被報告的併發症。我們將報告在我們五十個手術中唯一的併發腦部過度灌流症候群並導致致死性腦出血的病例。病患是一位76歲的男性，其過去病史有高血壓及腦梗塞且經血管攝影證實左頸動脈60％狹窄，其於是接受頸動脈支架及氣球擴張術，手術中並無不適，術後，病人偏頭痛伴隨以血壓不正常昇高，很不幸的，在術後兩小時後卻併發以致死性顱內出血，病患經保守治療而於五天後死亡。事實上，在術後的偏頭痛及高血壓都是腦部過度灌流症候群的前兆，我們將討論頸動脈支架術後的腦部過度灌流症候群之病理機轉，在文獻回搠中發現嚴格的血壓控制是處置腦部過度灌流症候群之可行的辦法之一。我們也於此提出即早辨識腦部過度灌流症候群之必要性，因為及早辨識此一可能致命的病徵可以增加評估與進一步處置的空間，其可能對於預後有益。

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並列摘要

The hyperperfusion syndrome is a recognized complication of carotid endarterectomy. Reports of cerebral hyperperfusion injury following internal carotid artery angioplasty and stenting are few We report a case of 76-year-old hypertensive man who was admitted to our hospital for assessment 2 years after experiencing an ischemic stroke of right hemisphere. Angiography confirmed 60% stenosis of left internal carotid artery(ICA). Percutaneous transluminal stenting of left internal carotid artery was performed without any immediate complications. Two hours after the procedure, the patient suddenly deteriorated. Computed to-mography (CT) of the brain revealed extensive intracerebral hemorrhage and he died 5 days later. There was precipitating migranous headache, and his blood pressure was moderately elevated at the time of deterioration. Sentinel headache could solely indicate the early sign of hyperperfusion injury after carotid stenting, especially in the presence of arterial hypertension. Patients with sentinel headache after angioplasty should be recognized early and they deserve intensive study for other features of cerebral hyperperfusion injury and prompt early management.

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hyperperfusion syndrome-carotid stenting

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Early Recognition of Cerebral Hyperperfusion syndrome after Carotid Stenting - a Case Report

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