脑动脉支架治疗相关的脑过度灌注综合征.ppt

脑动脉支架治疗相关的脑过度灌注综合征广东省人民医院神经科王硕

脑过度灌注综合症(CerebralHyperperfusionSyndrome,CHS）

Intracranialhemorrhageassociatedwithcerebralhyperperfusionsyndromefollowingcarotidendarterectomyandcarotidarterystenting:retrospectivereviewof4494patients.JNeurosurg.2007Dec;107(6):1130-6.DepartmentofNeurosurgery,IwateMedicalUniversity,Morioka,Japan.Retrospectivestudyforhyperperfusionsyndromein4494(CEA1596,CAS2898)Rateofhyperperfusion:1.4%includinghemorrhage(0.6%)Peakofhyperperfusion:CEA6thday,CASwithin12hrsRateofhyperperfusion:CEA1.9%,CAS1.1%Rateofhemorrhageassociatedwithhyperperfusion:CEA0.4%,CAS0.7%Patternofhemorrhage:CEAICH,CASICH+-SAHPoorprognosisincasesassociatedwithhemorrhage

男性，56岁诊断：右侧脑梗塞双侧颈内动脉狭窄高血压病3级、极高危

右颈内动脉重度狭窄

左侧颈内动脉狭窄

男，47岁高血压、冠心病、陈旧性心肌梗死（2002年）及高血脂诊断：短暂性脑缺血发作左侧大脑中动脉重度狭窄高血压病2级（极高危）冠心病陈旧性心肌梗死

HyperperfusionSyndromeAfterStentingforIntracranialVertebralStenosisMarcoTu′lioRezende,MD;LaurentSpelle,MD,PhD;CharbelMounayer,MD;MichelPiotin,MD;DanielGiansanteAbud,MD;JacquesMoret,MDStroke.2006;37:e12-e14.

AxialT2gradient-echoMRI24hoursaftertheprocedureshowsbilateralthalamichemorrhageAxialflairMRIshowsnolesionsinboththalami

HemorrhagiccomplicationsafterPTA/stentingforintracranialarterialstenosis3/130cases(2.3%)causedHemorrhageICH:2,SAH:1Hemorrhageapperedewinthin24hoursAllcaseshowedstageⅡonSPECT2cases(1.5%)recognizedhyperperfusionsyndromeJapan.

临床症状头痛（额颞）、面部和眼部疼痛恶心、呕吐癫痫发作局灶性症状（脑水肿、脑出血）精神症状？

发生机理慢性、长期------低灌注颅内血管极度扩张自动调节机制受损血流动力学储备受损HyperacuteIntracerebralHemorrhageComplicatingCarotidStentingShouldBeDistinguishedfromHyperperfusionSyndromeAJNRAmJNeuroradiol27:1508–13Aug2006primaryICH?

预示CHS因素

高灌注的预测与评估CBF检测：SPECT、PET、Xe-CT、Perfusion-CTTCD

预防

治疗控制血压抗凝和抗血小板治疗的控制依达拉奉？？（抗自由基）大血肿-----外科减压

总结脑血管介入治疗CHS评估：