Fatal subarachnoid hemorrhage after carotid stenting.
OBJECTIVE
Cerebral hyperperfusion syndrome with intracerebral hemorrhage (ICH) following carotid angioplasty and stent placement (CAS) of the internal carotid artery (ICA) is well known. We report the occurrence of fatal subarachnoid hemorrhage in a patient undergoing CAS.


METHODS
A 77-year-old woman experiencing a left-hemispheric transient ischemic attack underwent CAS for a 95% stenosis of the left ICA. CAS was performed without acute complications. At 5 hours the patient suddenly deteriorated. Her level of consciousness changed and she developed neck stiffness. CT of the brain revealed diffuse SAH with acute hydrocephalus.


CONCLUSIONS
Like ICH, SAH may develop as a severe complication after CAS. There are no reliable clinical symptoms preceding this fatal complication. However, several factors such as long-standing severe carotid stenosis with contralateral occlusion and increasing blood pressure after CAS accompanied by the extensive use of antithrombotic agents may predispose to this fatal complication.
Hartmann
M
M
Division of Neuroradiology, Department of Neurology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. marius_hartmann@med.uni-heidelberg.de
Weber
R
R
Zoubaa
S
S
Schranz
C
C
Knauth
M
M
D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D001921:Brain / Q000473:pathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D002533:Cerebral Angiography; D004292:Dominance, Cerebral / Q000502:physiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000473:pathology; D006940:Hyperemia / Q000000981:diagnostic imaging / Q000473:pathology; D019586:Intracranial Hypertension / Q000000981:diagnostic imaging / Q000473:pathology; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D015607:Stents / Q000009:adverse effects*; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed