Analysis Of Related Factors Of Cerebral Hyperperfusion Syndrome After Stenting For Internal Carotid Artery System Vascular Stenosis

Objective: To investigate the related factors of cerebral hyperperfusion syndrome after stenting for internal carotid artery system vascular stenosis.Method: Collecting 178 patients with stenosis of internal carotid artery system vascula and stent implantation in our hospital from January 2016 to December 2018,according to the occurrence of cerebral hyperperfusion syndrome(CHS)after operation,the patients were divided into hyperperfusion syndrome group and non-hyperperfusion syndrome group.Then according to different sites of stent implantation in patients,they were divided into three subgroups: the initial part of internal carotid artery,the non-initial part of internal carotid artery and the middle cerebral artery,to compare overall and subgroup the general clinical data of hyperperfusion syndrome group and non-hyperperfusion syndrome group,including sex,age,history of hypertension,history of coronary heart disease,history of diabetes mellitus,history of smoking and drinking,past stroke,blood lipid,glycosylated hemoglobin,homocysteine,timing of operation,postoperative whether use of free radical scavenger(edaravone),intraoperative and postoperative blood pressure;Imaging data,including compensatory capacity of collateral circulation,preoperative stenosis rate and residual stenosis rate whether there is significant difference.Result:1.In the overalll vascular stenosis stenting at internal carotid artery system: There were significant differences in postoperative blood pressure,stroke history,timing of operation,collateral circulation compensatory ability and preoperative stenosis rate between hyperperfusion group and non-hyperperfusion group(P<0.05).Bringing above-mentioned factors into the multivariate logistic regression analysis,the results showed that postoperative blood pressure(95%CI:2.398-55.508,OR=11.536,P=0.002),timing of operation(95%CI:1.149-26.580,OR=5.526,P=0.033),compensatory capacity of collateral circulation(95% CI:0.026-0.550,OR=0.120,P=0.006)were independent factors of CHS after stenting for internal carotid artery system vascular stenosis.Among them,postoperative high blood pressure and less than 2 weeks of operation were risk factors,while good compensation of collateral circulation was protective factor.2.In the subgroup analysis of vascular stenosis stenting at the initial part of the internal carotid artery,There were significant differences in postoperative blood pressure,stroke history,timing of operation,collateral circulation compensatory ability and preoperative stenosis rate between hyperperfusion group and non-hyperperfusion group(P<0.05).Bringing above-mentioned factors into the multivariate logistic regression analysis,the results showed that postoperative blood pressure(95%CI:1.351-89.819,OR=11.016,P=0.025),compensatory capacity of collateral circulation(95%CI:0.014-0.946,OR= 0.116,P=0.044)were independent factors of CHS after stenting at the beginning of the internal carotid artery vascular stenosis.Among them,postoperative high blood pressure was a risk factor,and good compensation of collateral circulation was a protective factor.3.In the subgroup analysis of vascular stenosis stenting at the middle cerebral artery,There were significant differences in postoperative blood pressure and collateral circulation compensatory ability between hyperperfusion group and non-hyperperfusion group(P<0.05).Bringing above-mentioned factors into the multivariate logistic regression analysis,the results showed that postoperative blood pressure(95%CI:1.168-206.628,OR=015.534,P=0.038)was an independent factor for CHS after vascular stenosis stenting at the middle cerebral artery,Among them,postoperative high blood pressure was a risk factor.Conclusion:1.Internal carotid artery system vascular stenosis stenting: postoperative high blood pressure,less than 2 weeks of operation and poor collateral circulation compensation are independent risk factors for CHS.2.Initial part of internal carotid artery vascular stenosis stenting: postoperative high blood pressure and poor collateral circulation compensation are independent risk factors for CHS.3.Middle cerebral vascular stenosis stenting: postoperative high blood pressure was an independent risk factor for CHS.