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Intracerebral hemorrhage risk may be increased with carotid stenting

WESTPORT, CT (Reuters Health) – While the exact prevalence is unknown, intracerebral hemorrhage may be more common after carotid stenting than after carotid endarterectomy (CEA), according to a report by German investigators.

Carotid stenting is being increasingly used as an alternative to CEA but without evidence of comparable safety, the researchers note.

In the November 27th issue of Neurology, Dr. Gerhard F. Hamann, from the University of Muenchen, and colleagues report a case of very early ipsilateral intracerebral hemorrhage after carotid percutaneous transluminal angioplasty (PTA) and stenting.

The patient, a 57-year-old man, presented with left-sided facial and limb weakness. Diagnostic studies revealed a high-grade stenosis of the right internal carotid artery. The patient underwent PTA with stenting.

Immediately after the angioplasty balloon was deflated, the mean blood flow velocity in the artery started to increase from a baseline value of 65 cm/s to a maximum of 150 cm/s after 3 minutes. Five minutes later, the patient developed a headache, left-sided hemiparesis, and deviation of the head and the eyes to the right.

The mean blood flow velocity normalized a few minutes later but a CT scan performed at this time showed a right-sided hemorrhage in the basal ganglia, the authors note. The patient underwent intensive rehabilitation therapy, but still required extensive help with daily activities 3 months later.

In previous reports of hyperperfusion-induced hemorrhage following PTA/stenting, the hyperperfusion was assumed but not documented. In the current report, however, the hyperperfusion was verified with transcranial Doppler sonography.

The authors therefore suggest that transcranial Doppler sonography may be crucial for identifying patients at increased risk of hemorrhage so that appropriate therapeutic strategies can be applied.

Neurology 2001;57:1933-1935.

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