(Stroke. 1999;30:2483-2486.)
© 1999 American Heart Association, Inc.
Case Reports |
Fatal Cerebral Reperfusion Hemorrhage After Carotid Stenting
From the Institute of Neurology, University College London, The National Hospital for Neurology and Neurosurgery, Queen Square (D.J.H.M., M.M.B.), and the Department of Neuroradiology, Atkinson Morley's Hospital, Copse Hill (A.C.), London, UK.
Correspondence to Prof Martin M. Brown, Professor of Stroke Medicine, Institute of Neurology, University College London, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. E-mail m.brown{at}ion.ucl.ac.uk
Background—The hyperperfusion syndrome is a recognized complication of carotid endarterectomy. Reports of cerebral hyperperfusion injury following internal carotid artery (ICA) angioplasty are few, and this complication has never been reported following internal carotid stenting.
Case Description—A 68-year-old normotensive man was referred to our hospital for assessment 5 months after experiencing a left hemispheric ischemic stroke. Angiography confirmed 95% stenosis of the left ICA. Left carotid percutaneous transluminal stenting was performed without any initial complications. Color Doppler ultrasound of the ICA immediately after stenting revealed an elevated peak systolic velocity of 2.3 m/s, in the absence of significant vessel stenosis or spasm on angiography. Seven hours after the procedure, the patient suddenly deteriorated. CT of the brain revealed extensive intracerebral hemorrhage (ICH), and he subsequently died 18 days later. There was no history of headache or seizure activity, and his blood pressure was only mildly elevated at the time of the deterioration. This is the first report of ICH after internal carotid stenting.
Conclusions—ICH may occur as a hyperperfusion phenomenon after internal carotid stenting, in the presence of mild to moderate arterial hypertension, without being heralded by any of the typical symptoms of the hyperperfusion syndrome. Patients with increased velocities on color Doppler ultrasound of the ICA after angioplasty should be monitored closely for features of cerebral hyperperfusion injury. Further studies are warranted to determine whether more aggressive treatment of mild to moderate hypertension after carotid stenting would reduce the likelihood of this potentially fatal complication.
Key Words: hypertension • intracerebral hemorrhage • stents • ultrasonography, Doppler
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