Portal de Periódicos da CAPES

Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting

2019; Elsevier BV; Volume: 12; Issue: 9 Linguagem: Inglês

10.1016/j.jcin.2019.01.247

1936-8798

José González García, Francisco Moniche, Irene Escudero‐Martínez, Fernando Mancha, Alejandro Tomasello, Marc Ribó, Fernando Delgado-Acosta, Juán José Ochoa, José A. de las Heras, Luis López-Mesonero, M. González-Delgado, Eduardo Murías, Joaquín Gil, Rosario Gil, Joaquín Zamarro, G. Parrilla, Sonia Mosteiro, María Dolores Fernández-Couto, L. Fernández de Alarcón, J.M. Ramírez-Moreno, Alain Luna, Alberto Forteza Gil, Andrés González‐Mandly, José Luis Caniego, Gustavo Zapata-Wainberg, Ernesto García, Pedro Pablo Alcázar Romero, Joaquín Ortega, Juan F. Arenillas, Pilar Algaba, Elena Zapata‐Arriaza, Jesús Alcalde-López, Asier de Albóniga-Chindurza, Aurelio Cayuela, Joan Montaner,

Cardiovascular Health and Disease Prevention

The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS).CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain.The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs).A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001).The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.