Fatal intracranial hemorrhage after carotid artery stenting: Three case reports and a literature review

Abstract

Introduction We herein describe three patients who developed fatal intracranial hemorrhage (ICH) after carotid artery stenting (CAS). Case Presentation: We retrospectively reviewed 126 patients who underwent CAS from January 2016 to December 2018 and identified 3 patients (2.4%) (all male, mean age of 59 years) who developed ICH after CAS. Two of them developed left basal ganglia hemorrhage with extension into the ventricle and subarachnoid space, and the third patient developed primary ventricular bleeding. One hemorrhage occurred immediately after CAS, whereas the other two occurred 3 hours and 8 hours after the procedure, respectively. The mean stenosis of the treated carotid arteries was 91%. All three hemorrhages were fatal, and the mean time from hemorrhage to death was 50 hours. Conclusion ICH is a potentially fatal complication of CAS and often occurs several hours after the procedure. Headache, vomiting, and consciousness disorders are the most common symptoms of ICH. Careful screening to identify high-risk patients and strict management of perioperative blood pressure are important to prevent this complication.

Prediction of intracranial hemorrhage after internal carotid artery stenting in patients with symptomatic severe carotid stenosis by computed tomography perfusion

“…Cerebral hyperperfusion syndrome (CHS) is an uncommon but critical complication after CAS, for which hyperperfusion-induced intracranial hemorrhage (ICH) is the most severe outcome if it is not managed properly and swiftly ( 2 , 3 ). The incidence of postoperative ICH following CAS is about 0.36–6.67%, and the mortality rate of ICH is about 75% ( 4 , 5 ). Although the incidence of postoperative ICH is low, given its detrimental consequences, it is an issue that needs to be urgently addressed in clinical practice.…”