Ischemic post-conditioning: A feasible preventive method for cerebral hyperperfusion syndrome secondary to revascularization

Cerebral hyperperfusion syndrome is a serious complication of revascularization after carotid endarterectomy, extracranial-intracranial bypass surgery, or stent placement. The mechanisms underlying cerebral hyper-perfusion syndrome are mainly ascribed to the dysfunction of cerebral autoregulation to blood flow and injury of the endothelia in blood vessels. Although blood pressure control is often used to prevent cerebral hyper-perfusion after revascularization, cases of cerebral hyperperfusion are still reported in the literature. Current animal studies have shown that ischemic post-conditioning has protective effects on brain tissue, and further studies also showed that it had positive effects on human brachial artery and heart. Therefore, we propose the hypothesis that ischemic post-conditioning could be used to prevent cerebral hyperperfusion syndrome following revascularization. Although the mechanism of ischemic post-conditioning and its clinical application should be further investigated, it has shown its potential effectiveness as a feasible method for prevention of cerebral hyperperfusion syndrome.