Dataset Information

Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery.

ABSTRACT:

Background

Cerebral hyperperfusion syndrome (CHS) following bypass surgery is a major cause of neurological morbidity and mortality. However, data regarding its prevention have not been assorted until date.

Objective

The objective of this study was to review the literature and evaluate whether any conclusion can be drawn regarding the effectiveness of any measure on preventing bypass-related CHS.

Methods

We systematically reviewed PubMed and Cochrane Library from September 2008 to September 2018 to collect data regarding the effectiveness of pharmacologic interventions on the refers to pretreatment (PRE) of bypass-related CHS. We categorized interventions regarding their class of drugs and their combinations and calculated overall pooled estimates of proportions of CHS development through random-effects meta-analysis of proportions.

Results

Our search yielded 649 studies, of which 23 fulfilled inclusion criteria. Meta-analysis included 23 studies/2,041 cases. In Group A (blood pressure [BP] control), 202 out of 1,174 pretreated cases developed CHS (23.3% pooled estimate; 95% confidence interval [CI]: 9.9-39.4), Group B (BP control + free radical scavenger [FRS]) 10/263 (0.3%; 95% CI: 0.0-14.1), Group C (BP control + antiplatelet) 22/204 (10.3%; 95% CI: 5.1-16.7), and Group D (BP control + postoperative sedation) 29/400 (6.8%; 95% CI: 4.4-9.6)].

Conclusions

BP control alone has not been proven effective in preventing CHS. However, BP control along with either a FRS or an antiplatelet agent or postoperative sedation seems to reduce the incidence of CHS.

SUBMITTER: Skandalakis GP

PROVIDER: S-EPMC10167845 | biostudies-literature | 2022 Oct-Dec

REPOSITORIES: biostudies-literature

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Publications

Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery.

Skandalakis Georgios P GP Kalyvas Aristotelis A Lani Evgenia E Komaitis Spyridon S Manolakou Danai D Chatzopoulou Despoina D Pantazis Nikos N Zenonos Georgios A GA Hadjipanayis Constantinos G CG Stranjalis George G Koutsarnakis Christos C

Brain circulation 20221001 4

<h4>Background</h4>Cerebral hyperperfusion syndrome (CHS) following bypass surgery is a major cause of neurological morbidity and mortality. However, data regarding its prevention have not been assorted until date.<h4>Objective</h4>The objective of this study was to review the literature and evaluate whether any conclusion can be drawn regarding the effectiveness of any measure on preventing bypass-related CHS.<h4>Methods</h4>We systematically reviewed PubMed and Cochrane Library from September ...[more]

PMID: 37181839

Similar Datasets

Project description:BackgroundCerebral hyperperfusion syndrome (CHS), characterized by severe ipsilateral headache, seizures, and intracranial hemorrhage, is a rare, poorly understood complication that can be fatal following carotid endarterectomy (CEA). The purpose of the study was to determine the factors associated with CHS as captured in the Vascular Quality Initiative.MethodsAnalysis was conducted on 51,001 procedures captured from the CEA module of the Vascular Quality Initiative from 2003 to 2015. Preoperative, operative, and postoperative variables were considered for inclusion in logistic regression analyses to determine possible associations with CHS. The relative contribution of each variable to the overall model was determined using dominance analysis.ResultsThe mean age was 70.2 ± 9.4 years; there were 39.6% female patients, 93.1% of white race, with 29.6% of CEAs being performed for symptomatic status. The overall rate of CHS was 0.18% (n = 94), with 55.1% occurring in asymptomatic and 44.9% occurring in symptomatic patients with an associated mortality rate of 38.2%. Multivariable analysis including preoperative variables showed that female gender (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.09-2.51; P = .019), <1 month major ipsilateral stroke (OR, 5.36; 95% CI, 2.35-12.22; P < .001), coronary artery disease (OR, 1.77; 95% CI, 1.15-2.71; P = .009), and contralateral stenosis ≥70% (OR, 1.54; 95% CI, 1.00-2.36; P = .050) were independently associated with CHS and that <1 month major stroke was the most important contributor to the model. With the additional inclusion of operative and postoperative variables, female gender (OR, 1.75; 95% CI, 1.14-2.67; P = .010), <1 month ipsilateral major stroke (OR, 3.20; 95% CI, 1.32-7.74; P = .010), urgency (OR, 2.25; 95% CI, 1.38-3.67; P = .001), re-exploration (OR, 2.98; 95% CI, 1.27-6.97; P = .012), postoperative hypertension (OR, 4.09; 95% CI, 2.65-6.32; P < .001), postoperative hypotension (OR, 3.21; 95% CI, 1.97-5.24; P < .001), dysrhythmias (OR, 3.23; 95% CI, 1.64-6.38; P = .001), and postoperative myocardial infarction (OR, 2.84; 95% CI, 1.21-6.67; P = .017) were significantly associated with CHS, with postoperative blood pressure lability and cardiac complications having the strongest associations with CHS.ConclusionsThe risk of CHS was highest in female patients and in those with a recent major stroke, coronary artery disease, and contralateral stenosis ≥70%. In addition, in adjusting for operative and postoperative variables, CHS was most significantly associated with postoperative blood pressure lability and cardiac complications. These data lend insight into a high-risk population for this devastating complication.

Project description:ObjectiveWe previously developed the use of side to side (s-s) bypass for the treatment of adult moyamoya disease (MMD) and discovered several kinds of distinct blood flow models intraoperatively, which we observed through indocyanine green-video angiography (ICG-VA). The purpose of this paper was to investigate the correlation between blood flow model (BFM) identified in s-s bypass and the incidence of postoperative cerebral hyperperfusion syndrome (CHS) among patients with MMD.MethodsWe analyzed 166 hemispheres from 153 patients diagnosed with MMD, including 118 hemispheres with s-s bypass and 48 with end to side (e-s) bypass. We categorized the enrolled patients into three pairs of comparison groups based on postoperative CHS (CHS or non-CHS) in s-s bypass, blood flow models (BFM I or BFM II) and surgical approach (s-s bypass or e-s bypass). Patients' demographics and characteristics were compared between groups.ResultsAmong patients who developed CHS, the occurrence of BFM I was more frequent than that of BFM II (0.154 vs. 0.019, p = 0.029 < 0.05) and no significant differences were noted in the remaining data. In the group of blood flow models, the proportion of patients with a history of cerebral hemorrhage was higher in BFM II compared to BFM I (0.062 vs. 0.226, p = 0.009 < 0.05), and the incidence of severity of ischemia was found to be higher in BFM I than in BFM II (0.774 vs. 0.429, p = 0.011 < 0.05), while the postoperative modified Rankin Scale (mRS) score and the Matsushima grade displayed no obvious difference. In comparison with the occurrence of CHS in e-s bypass group (7/48, 0.146), s-s bypass group had no difference (11/118, 0.093; p = 0.323 > 0.05), BFM I group showed no discrepancy (10/65, 0.154, p = 0.906 > 0.05) while BFM II group was different (1/53, 0.019, p = 0.047 < 0.05).ConclusionThe proportion of postoperative CHS occurring in BFM II during s-s bypass was lower than that in e-s bypass and BFM I. The postbypass blood flow model in s-s bypass may serve as a novel predictor for postoperative CHS.

Project description:ContextPatients with symptomatic atherosclerotic internal carotid artery occlusion (AICAO) and hemodynamic cerebral ischemia are at high risk for subsequent stroke when treated medically.ObjectiveTo test the hypothesis that extracranial-intracranial (EC-IC) bypass surgery, added to best medical therapy, reduces subsequent ipsilateral ischemic stroke in patients with recently symptomatic AICAO and hemodynamic cerebral ischemia.DesignParallel-group, randomized, open-label, blinded-adjudication clinical treatment trial conducted from 2002 to 2010.SettingForty-nine clinical centers and 18 positron emission tomography (PET) centers in the United States and Canada. The majority were academic medical centers.ParticipantsPatients with arteriographically confirmed AICAO causing hemispheric symptoms within 120 days and hemodynamic cerebral ischemia identified by ipsilateral increased oxygen extraction fraction measured by PET. Of 195 patients who were randomized, 97 were randomized to receive surgery and 98 to no surgery. Follow-up for the primary end point until occurrence, 2 years, or termination of trial was 99% complete. No participant withdrew because of adverse events.InterventionsAnastomosis of superficial temporal artery branch to a middle cerebral artery cortical branch for the surgical group. Antithrombotic therapy and risk factor intervention were recommended for all participants.Main outcome measureFor all participants who were assigned to surgery and received surgery, the combination of (1) all stroke and death from surgery through 30 days after surgery and (2) ipsilateral ischemic stroke within 2 years of randomization. For the nonsurgical group and participants assigned to surgery who did not receive surgery, the combination of (1) all stroke and death from randomization to randomization plus 30 days and (2) ipsilateral ischemic stroke within 2 years of randomization.ResultsThe trial was terminated early for futility. Two-year rates for the primary end point were 21.0% (95% CI, 12.8% to 29.2%; 20 events) for the surgical group and 22.7% (95% CI, 13.9% to 31.6%; 20 events) for the nonsurgical group (P = .78, Z test), a difference of 1.7% (95% CI, -10.4% to 13.8%). Thirty-day rates for ipsilateral ischemic stroke were 14.4% (14/97) in the surgical group and 2.0% (2/98) in the nonsurgical group, a difference of 12.4% (95% CI, 4.9% to 19.9%).ConclusionAmong participants with recently symptomatic AICAO and hemodynamic cerebral ischemia, EC-IC bypass surgery plus medical therapy compared with medical therapy alone did not reduce the risk of recurrent ipsilateral ischemic stroke at 2 years.Trial registrationclinicaltrials.gov Identifier: NCT00029146.

Dataset Information

Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery.

Background

Objective

Methods

Results

Conclusions

Publications

Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery.

Similar Datasets

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