Meta-Analysis Evaluates Effects of Cerebral Hyperperfusion Syndrome After CAS
September 5, 2018—A systematic review and meta-analysis of cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS) sought to assess the relevance of CHS in the postprocedural stroke rate. Anne E. Huibers, MD, et al published the findings in European Journal of Vascular and Endovascular Surgery (EJVES; 2018;56:322–333).
The investigators concluded in EJVES, "CHS is a serious and frequent complication in patients undergoing carotid angioplasty with stenting and is most likely to occur in the very early postprocedural period." They advised, "Future studies are encouraged to investigate the effect of intensive hemodynamic monitoring, including blood pressure control and assessment of cerebral blood flow, on the incidence of stroke caused by CHS after CAS."
For the study, a systematic search on incidence rates of CHS after CAS was conducted of the MEDLINE, EMBASE, and Cochrane databases. A metaregression analysis on CHS was performed to explain heterogeneity and determine the impact of potential risk factors on observed CHS. The Cowley criteria was used to assess the methodological quality of the studies. The study evaluated data from 33 studies, which were composed of 8,731 CAS patients.
In EJVES, the investigators reported:
- The pooled CHS risk was 4.6% (3.1%–6.8%).
- The stroke rate was 47% in CHS patients, of which 54% were fatal or disabling.
- The average time from procedure to symptoms was 12 hour (interquartile range, 8–36 hours).
- Impaired cerebrovascular reserve was associated with a higher risk of CHS after CAS.
- Symptomatic status was associated with a lower risk of CHS.