Intracranial hemorrhage and hyperperfusion syndrome following carotid artery stenting
Risk factors, prevention, and treatment
Alex Abou-Chebl, MD ,
Jay S. Yadav, MD*,*,
Joel P. Reginelli, MD*,
Christopher Bajzer, MD*,
Deepak Bhatt, MD* and
Derk W. Krieger, MD
* Department of Cardiovascular Medicine, Cleveland, OhioUSA
Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Figure 1 Preoperative angiograms (A and B) from Patient 1 show a 99% stenosis of the left internal carotid artery (ICA) (arrow in A) with delayed filling of the ICA compared with the external carotid artery (arrowhead in A) as well as an 80% stenosis of the origin of the right ICA (arrow in B). Computerized tomography scan of the brain (C) performed 1 h following left carotid stenting shows a large basal ganglia hemorrhage with mild subarachnoid hemorrhage.
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Figure 2 Preoperative angiograms (A and B) from Patient 2 show a 99% stenosis of the left internal carotid artery (ICA) (arrow in A) distal to a common carotid artery stenosis (arrowhead in A). The right ICA is occluded at its origin (arrow in B). Four days following stenting, a computerized tomography scan (C) shows a left frontal lobe, confluent hematoma.
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Figure 3 Angiograms from Patient 3 show a near occlusive lesion of the right internal carotid artery (ICA) (arrow in A) and an 80% stenosis of the left ICA (arrow in B). Three days following right carotid stenting, a computerized tomography of the brain (C) reveals a large right-hemisphere hematoma, with midline shift and intraventricular hemorrhage.
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