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 intra cerebral hemorrhage within the first four days following uncomplicated carotid endarterectomy (CEA). All operated-on lesions were greater th an 90% stenotic, and the contralateral internal carotid artery (ICA) w as 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, hemisph eric and nonhemispheric TIAs in 1, and nonhemispheric TIAs in the four th patient. None had experienced a prior stroke, and computed tomograp hy (CT) scans of the head performed preoperatively in 2 patients were negative. Three patients had a history of hypertension and all 4 requi red pharmacologic treatment for hypertension intraoperatively and/or d uring the first postoperative day in the intensive care unit. Three pa tients died and the fourth recovered. Intracerebral hemorrhage is an i nfrequent and serious potential complication of CEA. Patients who unde rgo operation for critical ICA stenoses in the setting of severe contr alateral ICA disease appear particularly vulnerable.