The Causes and Prophylaxis of the Hyperperfusion Syndrome in Patients after Carotid Endarterectomy

#VS 02-O-5
Vascular Surgery. SESSION-2
Oral

The Causes and Prophylaxis of the Hyperperfusion Syndrome in Patients after Carotid Endarterectomy

Anastasia Artemova¹, Nikolay Lukianchikov ², Petr Puzdryak ¹, Michael Ivanov ¹, Anastasia Uryupina¹, Anastasia Gorovaya ¹

¹Department of General Surgery of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia; ²I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation, Moscow, Russia;

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–B

Abstract

The aim of the research is to reveal the predictors of the development of the HS after performing carotid endarterectomy (CEA).

Materials and Methods: The study is based on the observation of 83 patients who underwent CEA, among whom 23 patients had asymptomatic carotid stenosis, 60 patients had neurological symptoms. The main group consists of 20 patients with hyperperfusion syndrome after CEA, the control group - 63 patients who did not have any HS manifestations. We analyzed: the severity of metabolic disorders in operated patients, changes in cognitive functions according to the MoCA scale, peculiarities of the perioperative period, deviations in arterial pressure, peculiarities of comorbid conditions and consequences of surgical intervention.

Results:In patients with HS, the manifestations of dyslipidemia were more common: the level of total cholesterol in the main group was 7.0±1.2 mmol/l, the LDL level was 3.6±0.6 mmol/l, in the control group - 4, 9±1.2 mmol/L and 2.9±0.7 mmol/L, respectively (p<0.05). In the main group, signs of carbohydrate disturbances were more often than in the control group (blood glucose level was 7.0±1.5 v/s 5.6±0.6, respectively, p<0.05).Stenosis of the contralateral carotid artery was noted more frequently in patients with signs of HS in the postoperative period (87±5.9% v/s 69.5±16.8%, respectively, p<0.05). Hemodynamically significant lesions of the vertebral and subclavian arteries were also more common among patients with HS when compared with the patients without such complications (25% and 95% v/s 1.59% and 20.63%, respectively, p<0.05).

Conclusions:Metabolic changes and features of atherosclerotic lesions of carotid arteries contribute a lot to the development of hyperperfusion syndrome after carotid endarterectomy. Adequate correction of metabolic disorders and considering the characteristics of brachycephalic artery lesions of during the operation can help reduce the frequency of manifestation of HS after CEA.