Case ReportHyperperfusion syndrome after trapping with high-flow bypass for a giant paraclinoid internal carotid artery aneurysm
Introduction
Hyperperfusion syndrome is known to occur after carotid endarterectomy, carotid artery stenting, and extracranial-intracranial bypass surgery. The syndrome has also been reported after aneurysmal surgery for a giant aneurysm after neck clipping and for a large aneurysm after flow diversion.1, 2, 3, 4, 5 However, to our knowledge, hyperperfusion syndrome has never been reported after trapping with high-flow bypass. We present a case of hyperperfusion syndrome after trapping with high-flow bypass of an unruptured giant paraclinoid internal carotid artery (ICA) aneurysm.
Section snippets
History
The patient, a 68-year-old right-handed woman, had symptoms of progressive loss of vision in her left eye and temporal visual field defect in her right eye. She had a history of hypertension and a family history of subarachnoid hemorrhage.
Examination
Magnetic resonance imaging (MRI) revealed a nonthrombotic left paraclinoid ICA giant aneurysm and local compression of the optic chiasma (Figure 1A). A three-dimensional time of flight magnetic resonance angiography also revealed attenuation in her ipsilateral
Discussion
Giant aneurysm has a dismal natural history and often results in hemorrhage, cerebral compression, and thromboembolism. Giant aneurysms of the intracranial ICA frequently involve the parent artery and critical neighboring branches, and direct surgical clip reconstruction is difficult in many cases. Trapping with high-flow bypass can completely exclude giant ICA aneurysms from the flow stream, promptly inducing thrombosis inside the aneurysm. Ischemia resulting from the bypass graft occlusion
Conclusion
When a giant ICA aneurysm, wherein blood flow is reduced on the side of the aneurysm, is trapped with high-flow bypass, the increase in blood flow through the bypass may lead to hyperperfusion syndrome. Postoperative SPECT and ASL-MRI may be useful in identifying potential cases of hyperperfusion syndrome.
Acknowledgment
The authors thank Editage (www.editage.jp) for English language editing.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.