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Intracerebral hemorrhage as a manifestation of cerebral hyperperfusion syndrome after carotid revascularization: systematic review and meta-analysis

  • Review Article - Vascular
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Abstract

Background

Intracerebral hemorrhage (ICH) in the context of cerebral hyperperfusion syndrome (CHS) is an uncommon but potentially lethal complication after carotid revascularization for carotid occlusive disease. Information about its incidence, risk factors and fatality is scarce. Therefore, we aimed to perform a systematic review and meta-analysis focusing on the incidence, risk factors and outcomes of ICH in the context of CHS after carotid revascularization.

Methods

We searched the PubMed and EBSCO hosts for all studies published in English about CHS in the context of carotid revascularization. Two reviewers independently assessed each study for eligibility based on predefined criteria. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the PROSPERO register was made (register no. CRD42016033190), including the pre-specified protocol.

Results

Forty-one studies involving 28,956 participants were deemed eligible and included in our analysis. The overall quality of the included studies was fair. The pooled frequency of ICH in the context of CHS was 38% (95% CI: 26% to 51%, I2 = 84%, 24 studies), and the pooled case fatality of ICH after CHS was 51% (95% CI: 32% to 71%, I2 = 77%, 17 studies). When comparing carotid angioplasty with stenting (CAS) with carotid endarterectomy (CEA), post-procedural ICH in the context of CHS was less frequent in CEA. ICH following CHS occurred less often in large series and was rare in asymptomatic patients. The most common risk factors were periprocedural hypertension and ipsilateral severe stenosis.

Conclusions

ICH as a manifestation of CHS is rare, more frequent after CAS and associated with poor prognosis. Periprocedural control of hypertension can reduce its occurrence.

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Authors and Affiliations

  1. Department of Biomedical Sciences and Medicine, University of Algarve, Campus da Penha, 8005-139, Faro, Portugal

    Pedro Abreu, Jerina Nogueira, Ana Marreiros & Hipólito Nzwalo

  2. Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal

    Filipe Brogueira Rodrigues

  3. Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal

    Filipe Brogueira Rodrigues

  4. Huntington’s Disease Centre, Institute of Neurology, University College London, London, UK

    Filipe Brogueira Rodrigues

  5. Department of Neurology, Centro Hospitalar do Algarve, Faro, Portugal

    Ana Nascimento & Mariana Carvalho

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  1. Pedro Abreu
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Correspondence to Hipólito Nzwalo.

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FBR is supported by the CHDI Foundation and EHDN. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Abreu, P., Nogueira, J., Rodrigues, F.B. et al. Intracerebral hemorrhage as a manifestation of cerebral hyperperfusion syndrome after carotid revascularization: systematic review and meta-analysis. Acta Neurochir 159, 2089–2097 (2017). https://doi.org/10.1007/s00701-017-3328-4

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