Massive intracerebral hemorrhage following carotid endarterectomy
D. H. Hafner, R. B. Smith 3rd, O. W. King, G. D. Perdue, M. T. Stewart, D. Rosenthal and W. D. Jordan
To our knowledge, a particularly lethal complication of carotid
endarterectomy, intracerebral hemorrhage, has not been given due
consideration in the literature concerning carotid surgery. In the Atlanta
area, massive intracranial hemorrhage developed in ten patients following
routine carotid endarterectomies performed during a recent ten-year period.
All ten of the patients in this series died despite a variety of
therapeutic interventions. Risk factors may include the following: extreme
arterial stenosis with resultant postoperative hyperperfusion, involvement
of multiple extracranial cerebral vessels, postoperative systemic
hypertension, and administration of anticoagulant or antiplatelet
medications. Unfortunately, identification of the subset of patients
potentially at risk for this complication is difficult, and, to date,
therapy has been generally ineffective.
