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Table 1 Key factors in the pathophysiology of cerebral hyperperfusion syndrome [1, 2, 1223]

From: Pathophysiology and management of reperfusion injury and hyperperfusion syndrome after carotid endarterectomy and carotid artery stenting

Factor Pathophysiology
Impaired auto-regulation and baroreceptor dysfunction Fluctuations in blood pressure
Post-operative hypertension
Increase in cerebral perfusion pressure
Risk of intracerebral hemorrhage in hypo-perfused tissues
Transient bradycardia and changes in cerebral blood flow
Chronic hypertension, microangiopathy and blood brain barrier Endothelial dysfunction and microangiopathy
Increased vessel permeability
Breakdown of blood brain barrier
Extravasation of albumin
Activation of TGFβ signaling pathways
Release of nitric oxide
Formation of free radicals Lipid peroxidation
Vascular endothelial damage
Cerebral edema
Degree of chronic carotid stenosis Chronic hypoperfusion
Endothelial damage
Imbalance of vasodilatory chemicals
Collateral circulation Changes in cerebral blood flow
Cerebral vasoreactivity