Zerebrales Hyperperfusionssyndrom nach Karotisrevaskularisation - ein Thema für den Hausarzt

Zusammenfassung

Hyperperfusion nach Revaskularisation ischämischer Gewebebezirke ist ein altbekanntes Phänomen. Sie ist meist selbstlimitierend, gelegentlich sogar erwünscht. Im Gehirn allerdings kann die Hyperperfusion katastrophale Folgen haben: die Symptome reichen von Krampfanfällen über neurologische Defizite bis zur meist tödlichen Hirnblutung. Es ist wichtig zu wissen, dass die Symptome erst Tage bis Wochen nach Revaskularisation auftreten können, was bedeutet, dass im Zuge der „Fast-track-Rehabilitation” weniger der Kliniker, eher der Hausarzt mit der Komplikation konfrontiert wird. Von besonderer Bedeutung ist die Frage, inwieweit „Hoch-Risiko-Patienten” präoperativ identifizierbar sind, bzw. ob unmittelbar postoperativ die Entwicklung eines Hyperperfusionssyndrom vorausgesehen werden kann und letztlich, ob auf die Ausprägung des Syndroms Einfluss genommen werden kann. Grundlage für die Analyse ist die Darstellung zweier eindrucksvoller Fälle, sowie eine Diskussion kritischer bzw. auffallender Befunde unter Berücksichtigung der umfassenden Literatur (Medline-Recherche). Die Arbeit kommt zu dem Ergebnis, dass nahezu alle als „Hoch-Risiko-Faktoren” bekannten Befunde in der Literatur kontrovers beurteilt werden und somit deren Vorhersagewert äußerst fraglich erscheint. Unwidersprochen ist lediglich, dass die Ausprägung der Symptome durch Blutdrucksenkung in Grenzen gehalten werden kann, auch wenn „Normotonie” vorliegt.

Abstract

Hyperperfusion following revascularization of ischemic organs is a well-known phenomenon. It is usually self-limiting and may corroborate success. In the brain, however, hyperperfusion may cause catastrophic consequences. Symptoms range from seizures and neurological deficits to intracerebral haemorrhage. It should be taken into consideration that symptoms may occur between days and even several weeks after revascularization. Therefore in times of “fast-track-rehabilitation” it is the family doctor who sees the patient's complication first. He should be familiar with the hyperperfusion syndrome. Most important are the questions, to what extent the patient at “high-risk” can be identified preoperatively, whether the development of hyperperfusion syndrome can be predicted in the postoperative period and furthermore, how the magnitude of syndrome can be influenced. By analyzing two impressive cases, critical and striking findings are isolated and discussed with the comprehensive literature. It can be seen that nearly all the findings which are known as “high-risk-factors” are inconsistently presented in the literature. Their predictive value seems to be extremely questionable. Consensus, however, consists in that the extent of the symptoms may be limited by intensive blood pressure control, even if the patient's pressure is “normal”.

Schlüsselwörter

zerebrales Hyperperfusionssyndrom - Karotisdesobliteration - Karotis-Stentangioplastie - intrakranielle Blutung

Key words

cerebral hyperperfusion syndrome - carotid endarterectomy - carotid artery stenting - intracerebral haemorrhage

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