CEREBRAL HYPERPERFUSION INJURY AFTER PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY OF EXTRACRANIAL ARTERIES

Cerebral hyperperfusion syndrome after carotid endarterectomy (CEA) is a rare but well-known phenomenon. Percutaneous transluminal angioplas ty (PTA) is being widely evaluated for treatment of selected stenoses of the extracranial arteries. Its benefits and risks still need to be established, Hyperperfusion injury (HI) after PTA of cerebral arteries has not been reported. We describe two patients with severe HI, one w ith a small putaminal haemorrhage and the other with diffuse basal sub arachnoid haemorrhage. In both cases, a typical clinical hyperperfusio n syndrome with headache, confusion, vomiting and seizures occurred. P atient 1 underwent PTA of the left carotid artery, both subclavian art eries and proximal vertebral arteries, patient 2 had carotid angioplas ty only. Transcranial Doppler ultrasound displayed markedly elevated b lood-flow velocities. HI may occur after PTA of extracranial arteries. The pathogenesis might be similar to reperfusion injury after CEA. Ou r findings suggest that: (1) HI may occur after PTA; (2) patients shou ld be monitored after PTA for HI; (3) further risk factors for HI need to be identified.