Alejandro González García1, Francisco Moniche2, Irene Escudero-Martínez2, Fernando Mancha3, Alejandro Tomasello4, Marc Ribó5, Fernando Delgado-Acosta6, Juán José Ochoa7, José A de Las Heras8, Luis López-Mesonero9, Montserrat González-Delgado10, Eduardo Murias11, Joaquín Gil12, Rosario Gil13, Joaquín Zamarro14, Guillermo Parrilla14, Sonia Mosteiro15, María Dolores Fernández-Couto16, Luis Fernández de Alarcón17, José M Ramírez-Moreno18, Alain Luna19, Alberto Gil20, Andrés González-Mandly21, José L Caniego22, Gustavo Zapata-Wainberg23, Ernesto García24, Pedro P Alcázar24, Joaquín Ortega25, Juan F Arenillas26, Pilar Algaba3, Elena Zapata-Arriaza27, Jesús Alcalde-López27, Asier de Albóniga-Chindurza27, Aurelio Cayuela28, Joan Montaner29. 1. Interventional Neuroradiology, Department of Radiology, Hospital Virgen del Rocío, Sevilla, Spain; Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain. Electronic address: ggjandro@gmail.com. 2. Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain; Department of Neurology, Hospital Virgen del Rocío, Sevilla, Spain. 3. Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain. 4. Interventional Neuroradiology, Department of Radiology, Hospital Vall d'Hebron, Barcelona, Spain. 5. Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain. 6. Interventional Neuroradiology, Department of Radiology, Hospital Reina Sofía, Córdoba, Spain. 7. Department of Neurology, Hospital Reina Sofía, Córdoba, Spain. 8. Interventional Neuroradiology, Department of Radiology, Hospital de Salamanca, Salamanca, Spain. 9. Department of Neurology, Hospital de Salamanca, Salamanca, Spain. 10. Department of Neurology, Hospital Universitario Central de Asturias, Oviedo, Spain. 11. Department of Radiology, Interventional Neuroradiology, Hospital Central de Asturias, Oviedo, Spain. 12. Interventional Neuroradiology, Department of Radiology, Hospital Clínico de Valencia, Valencia, Spain. 13. Department of Neurology, Hospital Clínico de Valencia, Valencia, Spain. 14. Interventional Neuroradiology, Department of Radiology, Hospital Virgen de la Arrixaca, Murcia, Spain. 15. Interventional Neuroradiology, Department of Radiology, Hospital Juán Canalejo, A Coruña, Spain. 16. Department of Neurology, Hospital Juan Canalejo, A Coruña, Spain. 17. Interventional Neuroradiology, Department of Radiology, Hospital Infanta Cristina, Badajoz, Spain. 18. Department of Neurology, Hospital Infanta Cristina, Badajoz, Spain. 19. Department of Neurology, Hospital de Cruces, Bilbao, Spain. 20. Interventional Neuroradiology, Department of Radiology, Hospital de Cruces, Bilbao, Spain. 21. Interventional Neuroradiology, Department of Radiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain. 22. Interventional Neuroradiology, Department of Radiology, Hospital de la Princesa, Madrid, Spain. 23. Department of Neurology, Hospital de la Princesa, Madrid, Spain. 24. Interventional Neuroradiology, Department of Radiology, Hospital Virgen de las Nieves, Granada, Spain. 25. Interventional Neuroradiology, Department of Radiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. 26. Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. 27. Interventional Neuroradiology, Department of Radiology, Hospital Virgen del Rocío, Sevilla, Spain. 28. Unit of Clinical Management of Public Health, Prevention and Promotion of Health, Area of Sanitary Management South of Sevilla, Sevilla, Spain. 29. Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla-IBiS, Sevilla, Spain; Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain.
Abstract
OBJECTIVES: 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). BACKGROUND: CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVES: 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). BACKGROUND:CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain. METHODS: 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). RESULTS: 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). CONCLUSIONS: 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.