CASE REPORT
O tratamento dos aneurismas intracranianos (AI), dilatação anormal de uma artéria cerebral, pode ser realizado tanto por técnica cirúrgica (clipagem e/ou wrapping) quanto por técnica endovascular, com embolização ou implante de stent diversor/redirecionador de fluxo, sendo este último baseado em redirecionamento do fluxo sanguíneo e remodelação do vaso, impedindo-o de entrar no aneurisma e resultando em trombose do AI. Neste relato de caso apresentamos uma complicação rara deste procedimento, a síndrome do hiperfluxo, mais observada em procedimentos pós-endarectomia, e que tem sido pouco descrita na literatura. Seus mecanismos não são totalmente compreendidos, sendo a principal hipótese a lesão endotelial com perda da autorregulação miogênica do fluxo sanguíneo cerebral, resultando em sintomas como convulsões e déficits neurológicos focais, que geralmente se resolvem em poucos dias.
Treatment of intracranial aneurysms (IA), abnormal dilatations of a cerebral artery, can be performed either by surgical technique (clipping and/or wrapping) or endovascular technique (embolization or flow diverter implantation), the last one being based on the blood flow redirection and vascular remodeling, preventing blood from entering the aneurysm and resulting in thrombosis of the IA. In this case report, a rare complication of this procedure, the hyperperfusion syndrome, mostly seen in post-endarectomy procedures, and that has been poorly described in the literature is presented. Its mechanisms are not fully understood, though the main hypothesis includes endothelial lesion with loss of myogenic autoregulation of cerebral blood flow, resulting in symptoms such as seizures and focal neurological deficits that usually resolve in a few days.
1. von Steinkirch C, Fujii Kato MV, Chyla MM, et al. Avaliação dos aneurismas intracranianos tratados no Instituto de Neurologia de Curitiba. J Bras Neurocir. 2017;28(3):159-66. http://dx.doi.org/10.22290/ jbnc.v28i3.1661.
2. Alves Aurich L, Giacomelli Leal A, Ramina R, Sousa de Meneses M. Balloon remodeling technique in endovascular treatment of intracranial aneurysms Técnica de remodelagem com balão no tratamento endovascular de aneurismas intracranianos. J Bras Neurocir. 2012;23(3):205-10. http://dx.doi.org/10.22290/jbnc.v23i3.1181.
3. Silva Júnior NR, Trivelato FP, Nakiri GS, et al. Endovascular treatment of residual or recurrent intracranial aneurysms after surgical clipping. J Cerebrovasc Endovasc Neurosurg. 2021;23(3):221-32. http://dx.doi. org/10.7461/jcen.2021.E2021.03.001. PMid:34470100.
4. Al-Mufti F, Cohen ER, Amuluru K, et al. Bailout strategies and complications associated with the use of flow-diverting stents for treating intracranial aneurysms. Interv Neurol. 2020;8(1):38-54. http://dx.doi. org/10.1159/000489016 PMid:32231694.
5. Chiu AHY, Wenderoth J. Cerebral hyperperfusion after flow diversion of large intracranial aneurysms. J Neurointerv Surg. 2013;5(6):e48-48. http://dx.doi.org/10.1136/neurintsurg-2012-010479.rep PMid:23188787.
6. Delgado MG, Bogousslavsky J. Cerebral hyperperfusion syndrome and related conditions. Eur Neurol. 2020;83(5):453-7. http://dx.doi. org/10.1159/000511307 PMid:33070131.
7. Walther NK. Cerebral hyperperfusion syndrome. Lancet Neurol. 2005;4(12):877-88. http://dx.doi.org/10.1016/S1474-4422(05)70251-9 PMid:16297845.
8. Narata AP, Janot K, Bibi R, et al. Reversible brain edema associated with flow diverter stent procedures: a retrospective single- center study to evaluate frequency, clinical evolution, and possible mechanism. World Neurosurg. 2019;122:e569-76. http://dx.doi.org/10.1016/j. wneu.2018.10.103. PMid:30394357.
9. García-Bargo MD, Martí-Fàbregas J, Belvís R, et al. Intracerebral haemorrhage by cerebral hyperperfusion after carotid angioplasty in a tandem lesion. A case report. Neurologia. 2004;19(5):273-6. PMid:15150712.
1MS, Medical student, Universidade Positivo, Curitiba, PR, Brazil.
2MS, Medical student, Centro Universitário Multivix, Vitória, ES, Brazil.
3MD, MR, Medical residency, Neurosurgery Division, Neurological Institute of Curitiba, Curitiba, PR, Brazil.
4MD, PhD, Neurologist, Neurology Division, Neurological Institute of Curitiba, Curitiba, PR, Brazil.
5MD, PhD, Neurosurgery Division, Neurological Institute of Curitiba, Curitiba, PR, Brazil.
Received Feb 27, 2023
Accepted May 18, 2023
