脑血管支架成形术后脑高灌注综合征

Cerebral Hyperperfusion Syndrome after Cerebral Artery Stenting

目的探讨脑动脉支架成形术后高灌注综合征(cerebral hyperperfusion syndrome,CHS)的发病机制及临床表现。方法回顾性分析中国人民解放军第306医院4例脑动脉狭窄支架成形术后发生CHS患者的临床资料。结果本组4例CHS中男性3例,女性1例,年龄43~77岁。2例行颈动脉狭窄支架成形术(carotid artery stenting,CAS),1例行CAS及椎动脉支架置入术,1例行基底动脉狭窄支架成形术。发生CHS症状时间在术后1 h^3 d。症状为头痛3例,右侧肢体偏瘫1例,视物不清1例,意识障碍1例,头计算机断层扫描(computed tomography,CT)提示脑实质出血2例,蛛网膜下腔出血1例,脑水肿1例。经降压、脱水等治疗后,3例均恢复良好,1例死亡。结论脑动脉支架成形术后CHS是一种少见及严重的疾病,需提高认识,尽早诊断,尽早治疗。

Objective To investigate the clinical manifestations and pathogenesis of cerebral hyperperfusion syndrome（CHS）.Methods The clinical data of 4 patients with CHS after cerebral artery stenting admitted to 306 th Hospital of PLA were analyzed retrospectively.Results The 4 patients were consisted of 3 men and 1 woman whose age ranged from 43 to 77 years old. Among the 4 cases,2 cases underwent carotid artery stenting（CAS）,1 case underwent CAS and vertebral artery stenting,and 1 case underwent basilar artery stenting. The symptoms of CHS occurred within 1 hour to 3 days after CAS. The clinical manifestations were that 3 cases with headache,1 case with hemiparesis of right limbs,1 cases with visual obstruction,and 1 case with coma. Head computed tomography（CT） suggested intracerebral hemorrahge in 2 cases,subarachnoid hemorrhage in 1 case,and brain edema in 1 case. After the treatment of controlling blood pressure and dehydration,3 patients recovered and 1 patient died.Conclusion CHS is an uncommon but serious complication after CAS. Improving our understanding of CHS may assist in identifying patients at risk in order to optimize CHS prevention and management strategies. The earlier diagnosis,the earlier treatment.