Intracerebral hemorrhage after carotid endarterectomy: Incidence, contribution to neurologic morbidity, and predictive factors

Abstract

Intracranial hemorrhage occurs with notable frequency after carotid endarterectomy and accounts for a significant proportion of neurologic morbidity and mortality. Younger patients, hypertensive patients, and patients with severe cerebrovascular occlusive disease appear to be at greatest risk for the complication.

Cerebral Hyperperfusion Syndrome After Angioplasty

“…The headache in CHS is usually moderate to severe and throbbing, similar to a migraine headache (Coutts et al, 2003), and it usually affects the same side as the artery treated. Headache may be the only manifestation of CHS (Connolly 2000;Ouriel et al, 1999;Sbarigia et al, 1993), so occasionally it has been considered a diagnostic criterion. After CEA, headaches are reported in 20% of patients without CHS, in 59% of those with CHS, and in 84% of those with ICH (Bouri et al, 2011).…”

“…After CEA, headaches are reported in 20% of patients without CHS, in 59% of those with CHS, and in 84% of those with ICH (Bouri et al, 2011). Postprocedural hypertension is a critical, though not essential, finding associated with CHS Schroeder et al, 1987;Ouriel et al 1999). Bouri et al review (2011) found that the mean systolic BP of CHS cases was 189 mmHg at presentation, and the proportion of patients with severe hypertension was significantly higher in patients who developed CHS after CEA than in those who did not.…”

“…Most Investigators recommend strict control of BP in the postoperative period to prevent ICH after CEA (Ahn et al, 1989;Bernstein et al, 1984;Bove et al, 1979;Buhk et al, 2006;Hosoda et al, 2001;Ko et al, 2005;Roh et al, 2005;Safian et al, 2006;Tang et al, 2008) and after CAS, as we will see below. It has been suggested that even BP in the normal range may be deleterious in patients at high risk for CHS (Piepgras et al, 1988;Ouriel et al, 1999;Jorgensen & Schroeder, 1993). Regarding strict control of BP, Abou-Chebl et al (2007) published an interesting study that analyzed the presence of CHS and ICH in 836 patients treated with CAS.…”

“…We will then discuss the risk factors, diagnostic methods, and strategies for prevention and treatment. We will also discuss a 11 increased the risk of intracranial hemorrhage (ICH) Macfarlane et al, 1991;Ouriel et al, 1999;Sbarigia et al, 1993). Preoperative significant reduction in flow velocity compared with baseline values is indicative of hypoperfusion and is associated with postoperative hyperperfusion (Keunen et al, 2001).…”

“…Propofol has been used in patients with CHS, it normalizes CBF, probably because of its effects on cerebral metabolism (Kaisti et al, 2003). Safety concerns have been raised about the effects of anticoagulants and antiplatelet agents and the risk of ICH following CEA, but no causal link has been found (Ouriel et al, 1999;Penn et al, 1995). Likewise, no association between these drugs and ICH has been found in patients undergoing CAS (Abou et al, 2003), although some studies have reported higher incidences of ICH, probably related to higher than usual doses of anticoagulants (Meyers et al, 2000 ;Morrish et al, 2000).…”