M Hartmann1, R Weber, S Zoubaa, C Schranz, M Knauth. 1. Division of Neuroradiology, Department of Neurology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. marius_hartmann@med.uni-heidelberg.de
Abstract
BACKGROUND AND PURPOSE: Cerebral hyperperfusion syndrome with intracerebral hemorrhage (ICH) following carotid angioplasty and stent placement (CAS) of the internal carotid artery (ICA) is well known. We report the occurrence of fatal subarachnoid hemorrhage in a patient undergoing CAS. CASE REPORT: A 77-year-old woman experiencing a left-hemispheric transient ischemic attack underwent CAS for a 95% stenosis of the left ICA. CAS was performed without acute complications. At 5 hours the patient suddenly deteriorated. Her level of consciousness changed and she developed neck stiffness. CT of the brain revealed diffuse SAH with acute hydrocephalus. CONCLUSIONS: Like ICH, SAH may develop as a severe complication after CAS. There are no reliable clinical symptoms preceding this fatal complication. However, several factors such as long-standing severe carotid stenosis with contralateral occlusion and increasing blood pressure after CAS accompanied by the extensive use of antithrombotic agents may predispose to this fatal complication.
BACKGROUND AND PURPOSE:Cerebral hyperperfusion syndrome with intracerebral hemorrhage (ICH) following carotid angioplasty and stent placement (CAS) of the internal carotid artery (ICA) is well known. We report the occurrence of fatal subarachnoid hemorrhage in a patient undergoing CAS. CASE REPORT: A 77-year-old woman experiencing a left-hemispheric transient ischemic attack underwent CAS for a 95% stenosis of the left ICA. CAS was performed without acute complications. At 5 hours the patient suddenly deteriorated. Her level of consciousness changed and she developed neck stiffness. CT of the brain revealed diffuse SAH with acute hydrocephalus. CONCLUSIONS: Like ICH, SAH may develop as a severe complication after CAS. There are no reliable clinical symptoms preceding this fatal complication. However, several factors such as long-standing severe carotid stenosis with contralateral occlusion and increasing blood pressure after CAS accompanied by the extensive use of antithrombotic agents may predispose to this fatal complication.
Authors: Nazli Janjua; Adnan I Qureshi; Adnan Qureshi; Jawad F Kirmani; Giuseppe Lanzino; Gene Sung; Jose I Suarez; Ali Ebrahimi; Afshin A Divani; Afshin Divani Journal: Neurocrit Care Date: 2005 Impact factor: 3.210