Cerebral hemodynamic changes following carotid endarterectomy: ‘cerebral hyperperfusion syndrome’

Carotid endarterectomy is associated with significant changes in cerebral hemodynamics. In the chronically ischemic brain of patients with carotid stenosis, this can result in postoperative development of ‘cerebral hyperperfusion syndrome’. This can cause severe cerebral edema, intracerebral hemorrhage and death. Impaired autoregulation as a result of endothelial dysfunction mediated by the generation of free oxygen radicals is implicated in the pathogenesis of cerebral hyperperfusion syndrome. Intensive blood pressure monitoring and control forms the backbone of treatment. Complete recovery occurs in mild cases, but disability and death can occur in more severe cases. This review concentrates on the mechanism, current management and identification of risk factors that can predispose to this rare but potentially life threatening complication.