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March 1987

Massive Intracerebral Hemorrhage Following Carotid Endarterectomy

Author Affiliations

From the Department of Surgery, Emory University School of Medicine, Atlanta (Drs Hafner, Smith, Perdue, and Stewart); and the Surgical Service, Veterans Administration Medical Center, Decatur, Ga (Dr Smith). Drs King, Rosenthal, and Jordan are in private practice in Atlanta.

Arch Surg. 1987;122(3):305-307. doi:10.1001/archsurg.1987.01400150059011

• To our knowledge, a particularly lethal complication of carotid endarterectomy, intracerebral hemorrhage, has not been given due consideration in the literature concerning carotid surgery. In the Atlanta area, massive intracranial hemorrhage developed in ten patients following routine carotid endarterectomies performed during a recent ten-year period. All ten of the patients in this series died despite a variety of therapeutic interventions. Risk factors may include the following: (1) extreme arterial stenosis with resultant postoperative hyperperfusion, (2) involvement of multiple extracranial cerebral vessels, (3) postoperative systemic hypertension, and (4) administration of anticoagulant or antiplatelet medications. Unfortunately, identification of the subset of patients potentially at risk for this complication is difficult, and, to date, therapy has been generally ineffective.

(Arch Surg 1987;122:305-307)