Intracerebral haemorrhage following carotid endarterectomy.
OBJECTIVE
To determine risk factors for the development of hyperperfusion and intra-cerebral haemorrhage following carotid endarterectomy and formulate potential protocols for prevention.


METHODS
MEDLINE database search of the English language literature (1966-2002) was performed using the words 'cerebral haemorrhage', 'intracranial haemorrhage' and 'carotid endarterectomy'. Other articles were cross-referenced by hand.


RESULTS
There are no data from randomised trials confirming the significance of any single risk factor. The evidence suggests that the following may have a role: pre-operative hypertension, recent ipsilateral non-haemorrhagic stroke, previous ischaemic cerebral infarction, surgery for a > 90% ipsilateral internal carotid artery (ICA) stenosis, impaired cerebrovascular reserve, intra-operative haemodynamic or embolic ischaemia, post-operative hypertension, an ipsilateral increase of > or =175% in peak middle cerebral artery velocity (MCAV) and/or a > or =100% increase in pulsatility index.


CONCLUSIONS
A critical ICA stenosis with impaired cerebrovascular reserve resulting in maximal intracerebral vasodilatation and post-operative hyperperfusion (impaired autoregulation) appear to be central to the development of ICH. Appropriate pre-operative screening and post-operative monitoring in high risk patients might identify those who would benefit from manipulation of the haemodynamic events that appear to promote ICH.
Russell
D A
DA
Vascular Surgical Unit, The General Infirmary at Leeds, Leeds, UK.
Gough
M J
MJ
D001794:Blood Pressure; D002343:Carotid Artery, Internal / Q000473:pathology; D016893:Carotid Stenosis / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D006801:Humans; D016343:Monitoring, Intraoperative; D018570:Risk Assessment; D012307:Risk Factors; D014664:Vasodilation