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一例大脑中动脉颅内支架植入术后的脑高灌注脑出血
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Abstract:
脑高灌注综合征(CHS)是脑血管重建术后罕见的并发症。它表现为同侧头痛、呕吐、癫痫发作和脑出血。既往报道颈动脉内膜切除术和支架植入术后高灌注综合征较常见，颅内支架植入术后出现的高灌注综合征则鲜有报道。一名77岁男性患者以被人发现言语不能3小时余入院。入院接受了脑血管数字减影血管造影(DSA)检查，结果显示左侧大脑中动脉M1段闭塞。急诊行左侧大脑中动脉M1段球囊扩张 + NEUROFORMEZ 4.0 mm × 20 mm支架植入术，术后造影见左侧大脑中动脉血流通畅，远端血管显影良好。4天后，患者突发意识不清加重伴双侧瞳孔不等大，左侧瞳孔3.5 mm，右侧瞳孔3.0 mm。头颅CT显示左侧基底节区及左侧额颞顶叶脑出血，量约170 mL，并脑疝形成。
Cerebral hyperperfusion syndrome (CHS) is a rare complication after cerebrovascular reconstruction surgery. It is manifested as ipsilateral headache, vomiting, epileptic seizures, and cerebral hemorrhage. Hyperperfusion syndrome was relatively common after extracranial carotid endarterectomy and stent implantation in the past, while hyperperfusion syndrome after intracranial stent implantation has been rarely reported. A 77-year-old male patient was admitted to the hospital more than 3 hours after being found unable to speak. The patient underwent digital subtraction angiography (DSA) of the cerebral vessels after admission, and the results showed occlusion of the M1 segment of the left middle cerebral artery. Emergency balloon dilation + NEUROFORMEZ 4.0 mm × 20 mm stent implantation in the M1 segment of the left middle cerebral artery was performed. Postoperative angiography showed smooth blood flow in the left middle cerebral artery and good visualization of the distal vessels. Four days later, the patient suddenly worsened in terms of clouded consciousness accompanied by unequal bilateral pupils (the left pupil was 3.5 mm and the right pupil was 3.0 mm). Head CT showed cerebral hemorrhage in the left basal ganglia region and the left frontal, temporal, and parietal lobes, with a volume of approximately 170 mL, and herniation formation.
| [1] | Ascher, E., Markevich, N., Schutzer, R.W., Kallakuri, S., Jacob, T. and Hingorani, A.P. (2003) Cerebral Hyperperfusion Syndrome after Carotid Endarterectomy: Predictive Factors and Hemodynamic Changes. Journal of Vascular Surgery, 37, 769-777. https://doi.org/10.1067/mva.2003.231 |
| [2] | Moulakakis, K.G., Mylonas, S.N., Sfyroeras, G.S. and Andrikopoulos, V. (2009) Hyperperfusion Syndrome after Carotid Revascularization. Journal of Vascular Surgery, 49, 1060-1068. https://doi.org/10.1016/j.jvs.2008.11.026 |
| [3] | Van Mook, W.N., Rennenberg, R.J., Schurink, G.W., van Oostenbrugge, R.J., Mess, W.H., Hofman, P.A., et al. (2005) Cerebral Hyperperfusion Syndrome. The Lancet Neurology, 4, 877-888. https://doi.org/10.1016/s1474-4422(05)70251-9 |
| [4] | Derdeyn, C.P., Chimowitz, M.I., Lynn, M.J., Fiorella, D., Turan, T.N., Janis, L.S., et al. (2014) Aggressive Medical Treatment with or without Stenting in High-Risk Patients with Intracranial Artery Stenosis (SAMMPRIS): The Final Results of a Randomised Trial. The Lancet, 383, 333-341. https://doi.org/10.1016/s0140-6736(13)62038-3 |
| [5] | Zaidat, O.O., Fitzsimmons, B., Woodward, B.K., Wang, Z., Killer-Oberpfalzer, M., Wakhloo, A., et al. (2015) Effect of a Balloon-Expandable Intracranial Stent vs Medical Therapy on Risk of Stroke in Patients with Symptomatic Intracranial Stenosis. JAMA, 313, 1240-1248. https://doi.org/10.1001/jama.2015.1693 |
| [6] | 孙瑄, 杨明, 余泽权, 等. 症状性颅内动脉粥样硬化性狭窄血管内治疗中国专家共识2022 [J]. 中国卒中杂志, 2022, 17(8): 863-888. |
| [7] | Abreu, P., Nogueira, J., Rodrigues, F.B., Nascimento, A., Carvalho, M., Marreiros, A., et al. (2017) Intracerebral Hemorrhage as a Manifestation of Cerebral Hyperperfusion Syndrome after Carotid Revascularization: Systematic Review and Meta-Analysis. Acta Neurochirurgica, 159, 2089-2097. https://doi.org/10.1007/s00701-017-3328-4 |
| [8] | Kaku, Y., Yoshimura, S. and Kokuzawa, J. (2004) Factors Predictive of Cerebral Hyperperfusion after Carotid Angioplasty and Stent Placement. American Journal of Neuroradiology, 25, 1403-1408. |
| [9] | Park, H.S., Nakagawa, I., Yokoyama, S., Motoyama, Y., Park, Y.S., Wada, T., et al. (2017) Amplitude of Tissue Oxygenation Index Change Predicts Cerebral Hyperperfusion Syndrome during Carotid Artery Stenting. World Neurosurgery, 99, 548-555. https://doi.org/10.1016/j.wneu.2016.12.062 |
| [10] | Abou-Chebl, A., Yadav, J.S., Reginelli, J.P., Bajzer, C., Bhatt, D. and Krieger, D.W. (2004) Intracranial Hemorrhage and Hyperperfusion Syndrome Following Carotid Artery Stenting. Journal of the American College of Cardiology, 43, 1596-1601. https://doi.org/10.1016/j.jacc.2003.12.039 |
| [11] | Coutts, S.B., Hill, M.D., Hu, W.Y. and Sutherland, G.R. (2003) Hyperperfusion Syndrome: Toward a Stricter Definition. Neurosurgery, 53, 1053-1060. https://doi.org/10.1227/01.neu.0000088738.80838.74 |
| [12] | Delgado, M.G. and Bogousslavsky, J. (2020) Cerebral Hyperperfusion Syndrome and Related Conditions. European Neurology, 83, 453-457. https://doi.org/10.1159/000511307 |
| [13] | Bakoyiannis, C.N., Tsekouras, N., Georgopoulos, S., et al. (2008) Can the Diameter of Endoluminal Shunt Influence the Risk of Hyperperfusion Syndrome after Carotid Endarterectomy? International Angiology, 27, 260-265. |
| [14] | Barnett, H.J.M., Taylor, D.W., Haynes, R.B., et al. (1991) Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis. The New England Journal of Medicine, 325, 445-453. |
| [15] | González García, A., Moniche, F., Escudero-Martínez, I., Mancha, F., Tomasello, A., Ribó, M., et al. (2019) Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results from a National Prospective Multicenter Study. JACC: Cardiovascular Interventions, 12, 873-882. https://doi.org/10.1016/j.jcin.2019.01.247 |
| [16] | Liu, A.Y., Do, H.M., Albers, G.W., et al. (2001) Hyperperfusion Syndrome with Hemorrhage after Angioplasty for Middle Cerebral Artery Stenosis. American Journal of Neuroradiology, 22, 1597-1601. |
| [17] | Ahn, S.S., Marcus, D.R. and Moore, W.S. (1989) Post-Carotid Endarterectomy Hypertension: Association with Elevated Cranial Norepinephrine. Journal of Vascular Surgery, 9, 351-360. https://doi.org/10.1016/0741-5214(89)90056-6 |
| [18] | Muzzi, D.A., Black, S., Losasso, T.J. and Cucchiara, R.F. (1990) Labetalol and Esmolol in the Control of Hypertension after Intracranial Surgery. Anesthesia & Analgesia, 70, 68-71. https://doi.org/10.1213/00000539-199001000-00011 |
| [19] | Strebel, S., Kaufmann, M., Anselmi, L. and Schaefer, H.G. (1995) Nitrous Oxide Is a Potent Cerebrovasodilator in Humans When Added to Isoflurane. A Transcranial Doppler Study. Acta Anaesthesiologica Scandinavica, 39, 653-658. https://doi.org/10.1111/j.1399-6576.1995.tb04143.x |
| [20] | Tietjen, C.S., Hurn, P.D., Ulatowski, J.A. and Kirsch, J.R. (1996) Treatment Modalities for Hypertensive Patients with Intracranial Pathology. Critical Care Medicine, 24, 311-322. https://doi.org/10.1097/00003246-199602000-00022 |
| [21] | Maltezos, C.K., Papanas, N., Papas, T.T., Georgiadis, G.S., Dragoumanis, C.K., Marakis, J., et al. (2007) Changes in Blood Flow of Anterior and Middle Cerebral Arteries Following Carotid Endarterectomy: A Transcranial Doppler Study. Vascular and Endovascular Surgery, 41, 389-396. https://doi.org/10.1177/1538574407302850 |
| [22] | Matsumoto, S., Nakahara, I., Higashi, T., Iwamuro, Y., Watanabe, Y., Takahashi, K., et al. (2009) Near-Infrared Spectroscopy in Carotid Artery Stenting Predicts Cerebral Hyperperfusion Syndrome. Neurology, 72, 1512-1518. https://doi.org/10.1212/wnl.0b013e3181a2e846 |
| [23] | Pennekamp, C.W.A., Immink, R.V., den Ruijter, H.M., Kappelle, L.J., Ferrier, C.M., Bots, M.L., et al. (2012) Near-infrared Spectroscopy Can Predict the Onset of Cerebral Hyperperfusion Syndrome after Carotid Endarterectomy. Cerebrovascular Diseases, 34, 314-321. https://doi.org/10.1159/000343229 |
