Clinical Analysis Of Cerebral Hyperpefrusion Syndrome After Revascularization Of Cerebral Artery Steno-occlusion Disease

Background: Cerebrovascular occlusion is a crucial part of neurosurgerydiagnosis. Carotid artery occlusive disease is the main formation ofneurosurgery diagnosis, among these cerebrovascular diseases, internal carotidartery stenosis, or even occlusion, is the common pattern in cerebrovasculardisease. According to the narrow location, we can distinguish in three parts: theinitial site, branch sites (which is common in middle cerebral artery),anddistant site. There into, the final conclusion from internal carotid artery distalprogressive stenosis to occlusion can form compensatory hyperplasia,expansion of aerosolized vascular network in basis brain, named MMD(Moyamoya Disease). The efficient treatment to cure cerebrovascular occlusivedisease is surgical operation, Compared with the traditional treatments,Revascularization of Cerebral Artery has obvious advantage, which shows toprevent and improve TIA (Transient Ischemic Attack) attack of transientcerebral ischemia, and to protect brain tissue to some extent. Even it can lowerthe risk Moyamoya Disease that caused compensatory hyperplasia ofangiorrhexis.Currently, main applied treatments in Revascularization of Cerebral Arteryare CEA (Carotid Endarterectomy), CAS (Carotid Artery Stenting) andSTA-MCA (Superficial Temporal Artery To Middle Cerebral Artery). Alongwith such kinds of surgeries’ extension and application, more and morecomplications are reported. Among these, the common complications deal withease. However, a kind of rare and serious complication, that is CHS (CerebralHyperperfusion Syndrome), attracted much attention. Mainly because narrowstate of cerebral vascular can be removed and the CBF (Statistical Analysis System) will add rapidly, finally goes beyond brain tissue compensatory ability.The clinical symptoms have varieties; the main feature is the pain in ipsilateralfrontotemporal and around orbit, sometimes shows headache, nausea and vomitingm,disturbance of consciousness, epilipsia as well as encephaledema and Focalneurologic symptoms caused by intracranial hemorrhage. Although CHS(Cerebral Hyperperfusion Syndrome) has different levels, the minor ones canrecover, however, there has potential danger in fatality rate and disability rate.Due to confusion between CHS (Cerebral Hyperperfusion Syndrome) clinicalsymptoms and Focal neurologic symptoms, lack of reorganization inRevascularization of Cerebral Artery at terms of CHS (CerebralHyperperfusion Syndrome), less identifications, and different views inliterature, so it is very significant to find a way to prevent, diagnose and treatCHS (Cerebral Hyperperfusion Syndrome).Objective: Aiming at lack of recognition of CHS (CerebralHyperperfusion Syndrome) in terms of Revascularization of Cerebral ArterySteno-occlusive Disease, the author will base on the influences to proceedretrospective study, explore the influential elements and prevent as well astreatment measures.Method: The author use retrospective analysis through29cases ofocclusive cerebrovascular disease, those who cure as Revascularization ofCerebral Artery, in the First Hospital of Jilin University from1st, Jan.2011to31st, Dec.2012. Among them, there are6cases of Internal carotid arterystenosis or occlusion treat as CEA (Carotid Endarterectomy),2cases ofmoyamoya disease treat as STA-MCA(Superficial Temporal Artery To MiddleCerebral Artery),21cases of internal carotid artery stenosis treat as CAS(Carotid Artery Stenting),5cases happened to CHS (Cerebral HyperperfusionSyndrome), based on these cases to analyze the influential elements andtreatment measures. Result: The21cases’ carotid artery stenosis rate of that29is70%~98%before the operation and the average rate is86%. The incidence of CSH is1702%. By statistical testing, the29cases are composed of2cases ofSTA-MCA of patients with MMD,6of CEA of carotid artery stenosis orocclusion and21of CAS of carotid artery or vertebral artery stenosis. There are24cases of men, which account for82.8%and5of women, accounting for17.2%with the average age of (54.4±12.0). Ages of patients with and withoutCHS are (52.4±6.6) and (54.9±12.9) respectively (P>0.05). There are16casesof hypertensive patients, accounting for55.7%;7cases of diabetic, accountingfor24.1%(P>0.05). All of the patients are diagnosed with cerebral vascularocclusive disease through DSA. Among the major clinical diagnosis cases,there are12of left internal carotid artery stenosis, accounting for41.4%;10ofright internal carotid artery stenosis, accounting for34.5%;1of left middlecerebral artery stenosis, accounting for3.5%;2of left vertebral artery stenosis,accounting for6.9%;2out of the10with right vertebral artery stenosis,accounting for6.9%and2of moyamoya disease, accounting for6.9%. Degreesof stenosis for patients with and without CHS are (91.8±8.1)%and(87.8±8.5)%respectively and t value0.98(P>0.05), which is not statisticallysignificant. There are21cases with multiple lesions, accounting for72.4%.From the surgical procedure selection perspective, there are6cases of CEA,accounting for20.7%;2of STA-MCA, accounting for6.9%as well as21ofCAS, accounting for72.4%and the disease type is of statistical significance forthe appearance of CHS (P<0.05). All the patients are operated with bloodvessel revascularization. There are15cases with symptoms improvedsignificantly, accounting for51.7%;13without significant improvement,accounting for44.8%and1of death which accounting for3.4%. After theoperation, there are12cases with postoperative hypertension, accounting for41.4%. When the time of operation is (167.0±161.3) minutes, there is no set of complications and there is not when the time is (128.3±89.2) minutes; and theblood losses during operation are (148.0±187.8) ml and (105.0±168.7) mlrespectively. Although the average values of time and blood loss are relativelyhigh in CHS set, the postoperative average values of length of stay（19.60±3.58）days and fees（10.07±0.52）million of patients with CHS complicationsare both higher than the average. P<0.05is with statistic significance.Conclusion: The conclusion with related references of CerebralHyperperfusion Syndrome after Revascularization of Cerebral ArterySteno-occlusive Disease.(1) CHS (Cerebral Hyperperfusion Syndrome) has a high-risk, enhancingthe length of the therapy and the hospital fee, there needs pay much attention toearly prevention. After clarified diagnosis, there needs expectant treatment. Sothe patient can recover well.(2) Some related pathogenesis, hazards, treatments of CerebralHyperperfusion Syndrome are not sure about. There need further research.