ORIGINAL ARTICLES   

International Angiology 1999 December;18(4):277-86

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Postcarotid endarterectomy symptoms. Pre- and postoperative clinical and MRI findings

Dimakos P. B., Tsiligiris V., Gouliamos A. *, Kotsis T. E., Katsaros G. **

From the Department of Vascular Surgery, 2nd Surgical Clinic, Radiological Department * Department of MRI and Computed Tomography ** Department of Anesthesiology, Aretaeion Hospital, Medical School, University of Athens, Greece

Background. The hyperperfusion syn­drome rep­re­sents a high­ly debat­ed clin­i­cal ­entity, with­out hav­ing yet any clin­i­cal­ly iden­ti­fi­able lim­its. The cor­re­la­tion of clin­i­cal with pre- and post­op­er­a­tive mag­net­ic res­o­nance imag­ing (MRI) find­ings fol­low­ing carot­id endar­te­rec­to­my in ­patients with a pos­sible hyper­per­fu­sion syn­drome was inves­ti­gat­ed.
Methods. Design: Prospective clin­i­cal and labor­a­to­ry study. Setting: At the Aretaieio University Hospital. Measures: Comparison to the post­op­er­a­tive clin­i­cal symp­to­mat­ic and MRI find­ings. Patients. We stud­ied 30 ­patients (mean age 66.6) of whom 14 (46.6%) were asymp­to­mat­ic, 16 (53.4%) were symp­to­mat­ic, 17 (56.6%) were hyper­ten­sive, 18 (60%) hyper­lip­i­daem­ic, 5 (16.6%) dia­bet­ic and 17 (56.6%) had cor­o­nary ­artery dis­ease.
Results. Twenty-one ­patients (70%) exhib­it­ed dis­tur­banc­es such as ipsi­lat­er­al head­ache, sei­zures, vom­it­ing or ­facial pain; imme­di­ate post­op­er­a­tive MRI scans ­revealed new ischaem­ic foci in 4 (19%) with­out any objec­tive neu­ro­log­i­cal find­ings. Lesions dis­played in post­op­er­a­tive MRI scans did not ­always cause symp­toms and nor­mal find­ings on MRI did not ­exclude the pres­ence of symp­toms. Hypertension ­favoured the pres­ence of sub­jec­tive dis­tur­banc­es, with­out nec­es­sar­i­ly any ­change in the MRI appear­anc­es. Preoperative MRI and clin­i­cal find­ings did not con­trib­ute to the iden­tifi­ca­tion of ­patients who might have exhib­it­ed post­op­er­a­tive symp­toms. Thus, the symp­tom­a­tol­o­gy ­remains ­unclear and open to ­debate, as a varie­ty of other con­di­tions may pro­duce the same clin­i­cal pic­ture post­op­er­a­tive­ly.
Conclusions. Subjective dis­tur­banc­es, objec­tive neu­ro­log­i­cal find­ings and MRI abnor­mal­ities with or with­out hyper­ten­sion may ­appear inde­pen­dent­ly after carot­id endar­te­rec­to­my, a fact which makes the path­o­gen­e­sis of the hyper­per­fu­sion syn­drome more dif­fi­cult to elu­ci­date.