Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study

• Published in: JACC. Cardiovascular interventions Vol. 12; no. 9; pp. 873 - 882
• Main Authors: González García, Alejandro, Moniche, Francisco, Escudero-Martínez, Irene, Mancha, Fernando, Tomasello, Alejandro, Ribó, Marc, Delgado-Acosta, Fernando, Ochoa, Juán José, de Las Heras, José A, López-Mesonero, Luis, González-Delgado, Montserrat, Murias, Eduardo, Gil, Joaquín, Gil, Rosario, Zamarro, Joaquín, Parrilla, Guillermo, Mosteiro, Sonia, Fernández-Couto, María Dolores, Fernández de Alarcón, Luis, Ramírez-Moreno, José M, Luna, Alain, Gil, Alberto, González-Mandly, Andrés, Caniego, José L, Zapata-Wainberg, Gustavo, García, Ernesto, Alcázar, Pedro P, Ortega, Joaquín, Arenillas, Juan F, Algaba, Pilar, Zapata-Arriaza, Elena, Alcalde-López, Jesús, de Albóniga-Chindurza, Asier, Cayuela, Aurelio, Montaner, Joan
• Format: Journal Article
• Language: English
• Published: United States 13.05.2019
• Subjects: stent; hyperperfusion; carotid
• ISSN: 1876-7605
• DOI: 10.1016/j.jcin.2019.01.247

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.