颈动脉支架成形术后脑高灌注综合征与高灌注现象4例报告

4 cases of cerebral hyperperfusion syndrome and cerebral hyperperfusion phenomenon following carotid artery stenting

目的:探讨颈动脉支架术后脑高灌注综合征(CHS)的发病机制、临床表现和预防治疗方法,加深临床对颈动脉支架术(CAS)后脑高灌注综合征认识。方法:回顾性分析我院颈动脉支架成形术后3例脑高灌注综合征和1例高灌注现象患者的临床资料,包括支架植入前后血压管理、临床特征、影像数据包括头部CT和数字减影动脉造影术(DSA)检查,经颅多普勒超声(TCD)监测术前术后大脑中动脉收缩期峰值流速,以及临床处理和临床结局。结果:4例患者经严格控制血压、脱水降颅压、加强监护后,脑血流速度恢复正常,脑高灌注临床症状缓解。结论:术前严格评估高危因素、术前术后严格控制血压、TCD严密观察脑血流是预防脑高灌注综合征的有效措施。

Objective： To discuss the pathogenesis, clinical manifestation and prevention and management of cerebral hyperperfusion syndrome （CHS） following carotid angioplasty and stenting （CAS）. Method： We retro- spectively reviewed the clinical data of 3 cases of hyperperfusion syndrome and a case of hyperperfusion phenome- non following CAS,including blood pressure management before and after stenting, monitoring of cerebral blood flow by TCD,the treatment and outcome of CHS. Result：Via strictly blood pressure control,dehydration for reduc- ing intracranial pressure,the cerebral blood flow resumed normal,the clinical symptoms of CHS relieved. Conclu- sion：Strictly assessment risk factors before CAS,strictly blood pressure control before and after CAS,TCD moni- tor cerebral blood flow are helpful for preventing CHS.