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ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 4  |  Page : 207-214

Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery


1 Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece; Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
2 Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece; Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada, Switzerland
3 Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
4 Department of Neurology, Hôpitaux Universitaires de Genève, Geneva University Hospitals, Geneva, Switzerland
5 Athens Microneurosurgery Laboratory, Department of Neurosurgery, University of Athens, Athens, Greece
6 Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
7 Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
8 Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY; Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Neurosurgery, Icahn School of Medicine Mount Sinai Beth Israel, Mount Sinai Health System, New York, NY, USA

Correspondence Address:
Georgios P Skandalakis
Department of Neurosurgery, University of Athens School of Medicine, Athens, Greece.

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bc.bc_43_22

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BACKGROUND: Cerebral hyperperfusion syndrome (CHS) following bypass surgery is a major cause of neurological morbidity and mortality. However, data regarding its prevention have not been assorted until date. OBJECTIVE: The objective of this study was to review the literature and evaluate whether any conclusion can be drawn regarding the effectiveness of any measure on preventing bypass-related CHS. METHODS: We systematically reviewed PubMed and Cochrane Library from September 2008 to September 2018 to collect data regarding the effectiveness of pharmacologic interventions on the refers to pretreatment (PRE) of bypass-related CHS. We categorized interventions regarding their class of drugs and their combinations and calculated overall pooled estimates of proportions of CHS development through random-effects meta-analysis of proportions. RESULTS: Our search yielded 649 studies, of which 23 fulfilled inclusion criteria. Meta-analysis included 23 studies/2,041 cases. In Group A (blood pressure [BP] control), 202 out of 1,174 pretreated cases developed CHS (23.3% pooled estimate; 95% confidence interval [CI]: 9.9–39.4), Group B (BP control + free radical scavenger [FRS]) 10/263 (0.3%; 95% CI: 0.0–14.1), Group C (BP control + antiplatelet) 22/204 (10.3%; 95% CI: 5.1–16.7), and Group D (BP control + postoperative sedation) 29/400 (6.8%; 95% CI: 4.4–9.6)]. CONCLUSIONS: BP control alone has not been proven effective in preventing CHS. However, BP control along with either a FRS or an antiplatelet agent or postoperative sedation seems to reduce the incidence of CHS.


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