Hyperperfusion Syndrome After Stent Placement for Subclavian Artery Stenosis

Abstract

A 60-year-old woman presented with a rare case of hyperperfusion syndrome after stent placement for subclavian artery stenosis manifesting as dizziness due to vertebrobasilar insufficiency. Three days after undergoing stent placement to treat the severely stenotic (90%) right subclavian artery, she suffered intracranial hemorrhage related to hyperperfusion syndrome. Preoperative single-photon emission computed tomography findings of low cerebral perfusion and poor perfusion reserve might indicate the possibility of hyperperfusion syndrome after stenting in patients with subclavian artery stenosis.

Single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm

“…Moreover, as in carotid revascularization, a sudden increase in the intracranial blood flow following the subclavian stenting may create a risk of rupture for the concomitant posterior circulation aneurysm. In our literature review, we could find no cases of intracranial aneurysm rupture following subclavian stenting, but intracranial hemorrhage due to hyperperfusion was reported in two patients (30,31). Therefore, it is necessary to secure the ipsilateral intracranial aneurysm in patients for whom subclavian artery stenting is planned.…”

How to identify risk for cerebral hyperperfusion syndrome after carotid revascularization procedures

“…CHS can develop at any time; immediately after the procedure to up to a month later, but the majority of patients develop symptoms within the first few days (mean 5 days) 7,20,21 . Although this most commonly appears after CAS and CEA, CHS was described and after the subclavian artery stenting 20 and after the endovascular reconstruction of carotid artery in a high-flow carotid-jugular fistula 21 . The reported incidence rate of CHS and ICH after CEA is 1.9% and 0.37% and 1.16% and 0.74% after CAS 3,6,7,[10][11][12]22 .…”

Intracranial Stents Past, Present and the Future Trend: Stents Made with Nano-particle or Nanocomposite Biomaterials

“…It is caused by a sudden increase in blood flow to an under-perfuse region of the brain, leading to brain tissue edema and secondary hemorrhage (the risk of intracranial hemorrhage in stent angioplasties is 1.2%), both of which can be fatal [37]. The risk raise as the degree of stenosis increases.…”