Incidence and etiology of intracerebral hemorrhage following carotid endarterectomy

Abstract

In a consecutive series of 1930 carotid endarterectomies there were eight cases of postoperative intracerebral hemorrhage. One of these patients was operated on 2 weeks following cerebral infarction and had severe uncontrollable hypertension after surgery. A second patient had an intraoperative embolus and bled while fully heparinized on the 3rd postoperative day. Only one patient in the series bled into an area of documented cerebral infarction. The remainder of the cases represented hemorrhage into essentially normal brain. Seven of the eight patients with intracerebral hemorrhage had high-grade internal carotid artery stenosis preoperatively. Although several factors have contributed to the brain hemorrhages in this series of patients, postoperative cerebral hyperperfusion which often follows endarterectomy may have played an important role. Defective cerebrovascular autoregulation in chronically ischemic brain regions may predispose patients to intracerebral hemorrhage after removal of a high-grade stenosis of the internal carotid artery.

Cerebral Hemodynamic Benefits after Contralateral Carotid Artery Stenting in Patients with Internal Carotid Artery Occlusion

“…[32][33][34] To prevent this syndrome, strict control of blood pressure during the postoperative period has been emphasized in many reports. [22][23][24]33 Hyperperfusion did not occur in any of our patients; however, the possible occurrence of this condition should be recognized. Conversely, too much reduction of blood pressure can lead to hemodynamic ischemia, especially on the side of ICA occlusion.…”

“…"Cerebral hyperperfusion syndrome," which is defined as a major increase in ipsilateral CBF to well above the metabolic demands of the brain tissue following the repair of carotid artery stenosis, 22,23 is a rare but potentially catastrophic complication after CEA or CAS. [24][25][26][27][28][29][30][31][32] The mechanism remains unclear, but preoperative impairment of autoregulation due to chronic hypoperfusion resulting from contralateral ICA occlusion is one of the risk factors. [32][33][34] To prevent this syndrome, strict control of blood pressure during the postoperative period has been emphasized in many reports.…”

Acute intracerebral haemorrhage complication after carotid artery stenting

“…However, first studies reported an incidence of 0.3-1.2% of cerebral hyperperfusion syndrome associated with intracerebral haemorrhage after carotid angioplasty and stent placement, while more recent studies showed a relatively higher rate of up to 5% [1,2,3].…”

Periprocedural Evaluation and Management against Cerebral Hyperperfusion Syndrome after Carotid Artery Stenting in Japan: A Nationwide Questionnaire Survey

“…Sometimes, this can cause intracranial hemorrhage (ICH) with significant neurological sequelae. 1,2,5,6) The Japanese Society for Treatment at Neck in Cerebrovascular Disease (JASTNEC) Study retrospectively registered and examined 4494 Japanese patients who underwent CEA or CAS between April 2000 and March 2005. This study found the rates of CHS and ICH after CAS to be 1.1% and 0.7%, respectively, with the morbidity and mortality rates in patients with ICH after carotid revascularization procedure shown to be 65% and 26%, respectively.…”