Post-Carotid-Endarterectomy Intracerebral Hemorrhage: A Continuing Challenge. Case Reports

Over the past decade, 2 men and 2 women, ranging in age from sixty-two to seventy-seven (mean, 69.8) years, experienced strokes due to intracerebral hemorrhage within the first four days following uncomplicated carotid endarterectomy (CEA). All operated-on lesions were greater than 90% stenotic, and the contralateral internal carotid artery (ICA) was completely occluded in 3 patients and greater than 90% stenotic in the other patient. All 4 patients had a history of transient ischemia, including hemispheric transient ischemic attacks (TIAs) in 2, hemispheric and nonhemispheric TIAs in 1, and nonhemispheric TIAs in the fourth patient. None had experienced a prior stroke, and computed tomography (CT) scans of the head performed preoperatively in 2 patients were negative. Three patients had a history of hypertension and all 4 required pharmacologic treatment for hypertension intraoperatively and/or during the first postoperative day in the intensive care unit. Three patients died and the fourth recovered. Intracerebral hemorrhage is an infrequent and serious potential complication of CEA. Patients who undergo operation for critical ICA stenoses in the setting of severe contralateral ICA disease appear particularly vulnerable.