Publication: Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study.
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2019
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Abstract
The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS). CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain. The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs). A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001). The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.
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MeSH Terms
Age Factors
Aged
Aged, 80 and over
Carotid Stenosis
Cerebrovascular Circulation
Cerebrovascular Disorders
Consciousness Disorders
Endovascular Procedures
Female
Headache
Hemodynamics
Humans
Male
Middle Aged
Prospective Studies
Renal Insufficiency, Chronic
Risk Assessment
Risk Factors
Seizures
Severity of Illness Index
Sex Factors
Spain
Stents
Time Factors
Treatment Outcome
Aged
Aged, 80 and over
Carotid Stenosis
Cerebrovascular Circulation
Cerebrovascular Disorders
Consciousness Disorders
Endovascular Procedures
Female
Headache
Hemodynamics
Humans
Male
Middle Aged
Prospective Studies
Renal Insufficiency, Chronic
Risk Assessment
Risk Factors
Seizures
Severity of Illness Index
Sex Factors
Spain
Stents
Time Factors
Treatment Outcome
DeCS Terms
CIE Terms
Keywords
carotid, hyperperfusion, stent