Document Detail

Cerebral haemorrhage after carotid endarterectomy.
MedLine Citation:
PMID:  8739929     Owner:  NLM     Status:  MEDLINE    
Cerebral stroke is a serious complication related to carotid endarterectomy (CEA), being most frequently caused by thromboembolic events and less frequently on account of cerebral haemorrhage. The present series comprised five out of 857 (0.6%) patients who had undergone CEA at Oulu University Hospital between the years 1974 and 1993 and suffered a postoperative stroke four to 13 days after surgery due to intracerebral haemorrhage (IH). Preoperatively, all these patients were neurologically intact, with transient ischaemic attacked (TIA) as the main indication for CEA. All five patients had a history of arterial hypertension treated adequately preoperatively, and one patient had high blood pressure levels after surgery. Critical ipsilateral stenosis of the internal carotid artery (> 90%) was detected in the preoperative angiogram in all five cases. The primary outcome after CEA was uneventful in every case, without any signs of neurological deficiency. The symptoms, comprising severe headache, convulsions and/or hemiparesis occurred suddenly four to 13 days (mean seven days) after CEA. The diagnosis of IH was based on computed tomography (CT) findings. All five patients were treated conservatively. Three of them died. We conclude that even normotensive, neurologically intact patients without demonstrable cerebral infarction or postoperative hypertension may suffer cerebral haemorrhage after the relief of high-grade carotid stenosis. The role of possible insufficiency of the autoregulatory mechanisms of the cerebral vasculature on account of long-standing critical stenosis of the internal carotid artery and subsequent uncontrolled hyperperfusion following CEA are discussed.
M Lepojärvi; T Peltola; K Ylönen; T Juvonen; R Pokela; P Kärkölä
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annales chirurgiae et gynaecologiae     Volume:  85     ISSN:  0355-9521     ISO Abbreviation:  Ann Chir Gynaecol     Publication Date:  1996  
Date Detail:
Created Date:  1996-10-25     Completed Date:  1996-10-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7609767     Medline TA:  Ann Chir Gynaecol     Country:  FINLAND    
Other Details:
Languages:  eng     Pagination:  23-6     Citation Subset:  IM    
Department of Surgery, Oulu University Hospital, Finland.
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MeSH Terms
Blood Pressure / physiology
Carotid Artery, Internal / radiography,  surgery
Carotid Stenosis / mortality,  radiography,  surgery*
Cerebral Angiography
Cerebral Hemorrhage / etiology*,  mortality,  radiography
Endarterectomy, Carotid*
Follow-Up Studies
Ischemic Attack, Transient / etiology,  mortality,  radiography
Middle Aged
Neurologic Examination
Risk Factors
Survival Rate
Tomography, X-Ray Computed

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