Hyperperfusion-induced intracerebral hemorrhage after carotid stenting documented by TCD

Abstract

Intracerebral hemorrhage (ICH) is a rare complication of carotid endarterectomy (CEA) occurring in less than 1% of patients.1 Carotid percutaneous transluminal angioplasty (PTA) with or without stenting is considered an alternative to CEA. Evaluations of the complications following carotid PTA/stenting are of interest because it is being increasingly used without evidence of safety comparable to that of CEA. The frequency of ICH after PTA may differ from that after CEA because the PTA/stenting procedure requires peri- and postintervention anticoagulation and antithrombotic treatment. Hyperperfusion is thought to play a major role in postintervention ICH. Owing to defective autoregulation in brain regions with preexisting chronic misery perfusion, revascularization may lead to a marked increase of ipsilateral cerebral blood flow (CBF), causing perfusion pressures to overwhelm arterial and arteriolar vasoconstriction.2 The consequence is that distal microvessels may rupture, resulting in ICH. Few cases of intracerebral hemorrhage have been reported to occur after PTA/stenting.3-7⇓⇓⇓⇓ We report on a case of very early ipsilateral intracerebral hemorrhage after …