Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery
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...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Brain Circulation |
| Subjects: | |
| Online Access: | http://www.braincirculation.org/article.asp?issn=2394-8108;year=2022;volume=8;issue=4;spage=207;epage=214;aulast=Skandalakis |
| _version_ | 1797955103665160192 |
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| author | Georgios P Skandalakis Aristotelis Kalyvas Evgenia Lani Spyridon Komaitis Danai Manolakou Despoina Chatzopoulou Nikos Pantazis Georgios A Zenonos Constantinos G Hadjipanayis George Stranjalis Christos Koutsarnakis |
| author_facet | Georgios P Skandalakis Aristotelis Kalyvas Evgenia Lani Spyridon Komaitis Danai Manolakou Despoina Chatzopoulou Nikos Pantazis Georgios A Zenonos Constantinos G Hadjipanayis George Stranjalis Christos Koutsarnakis |
| author_sort | Georgios P Skandalakis |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-10T23:29:05Z |
| format | Article |
| id | doaj.art-f90621839fda4c9e8c477788e169384d |
| institution | Directory Open Access Journal |
| issn | 2455-4626 |
| language | English |
| last_indexed | 2024-04-10T23:29:05Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Brain Circulation |
| spelling | doaj.art-f90621839fda4c9e8c477788e169384d2023-01-12T11:17:58ZengWolters Kluwer Medknow PublicationsBrain Circulation2455-46262022-01-018420721410.4103/bc.bc_43_22Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgeryGeorgios P SkandalakisAristotelis KalyvasEvgenia LaniSpyridon KomaitisDanai ManolakouDespoina ChatzopoulouNikos PantazisGeorgios A ZenonosConstantinos G HadjipanayisGeorge StranjalisChristos KoutsarnakisBACKGROUND: 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.http://www.braincirculation.org/article.asp?issn=2394-8108;year=2022;volume=8;issue=4;spage=207;epage=214;aulast=Skandalakisbypass surgerycerebral bypasscerebral hyperperfusion syndromecerebral revascularizationhyperperfusion syndromeintracranial bypassreperfusion injury |
| spellingShingle | Georgios P Skandalakis Aristotelis Kalyvas Evgenia Lani Spyridon Komaitis Danai Manolakou Despoina Chatzopoulou Nikos Pantazis Georgios A Zenonos Constantinos G Hadjipanayis George Stranjalis Christos Koutsarnakis Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery Brain Circulation bypass surgery cerebral bypass cerebral hyperperfusion syndrome cerebral revascularization hyperperfusion syndrome intracranial bypass reperfusion injury |
| title | Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery |
| title_full | Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery |
| title_fullStr | Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery |
| title_full_unstemmed | Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery |
| title_short | Effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery |
| title_sort | effectiveness of pharmacologic interventions for prevention of cerebral hyperperfusion syndrome following bypass surgery |
| topic | bypass surgery cerebral bypass cerebral hyperperfusion syndrome cerebral revascularization hyperperfusion syndrome intracranial bypass reperfusion injury |
| url | http://www.braincirculation.org/article.asp?issn=2394-8108;year=2022;volume=8;issue=4;spage=207;epage=214;aulast=Skandalakis |
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