title: Contralateral hyperacute intracerebral hemorrhage after carotid artery stenting with contralateral internal carotid artery occlusion.
abstract: An 87-year-old man sustained an intracerebral hemorrhage in the watershed area of the contralateral frontal lobe immediately after carotid artery stenting (CAS) for severe cervical internal carotid artery (ICA) stenosis. The contralateral cervical ICA was occluded. CAS resulted in increased cross-flow through the anterior communicating artery and increased flow in the contralateral middle cerebral artery. This case demonstrates that CAS in patients with contralateral ICA occlusion and insufficient collateral flow can cause dramatically increased collateral flow through the circle of Willis and result in contralateral hyperperfusion. In patients with severely compromised cerebral perfusion, measures should be taken to prevent hyperperfusion-related complications.
authors.affiliation: Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan. Electronic address: takami-tky@umin.ac.jp.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Takami
authors.affiliation: Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hanakawa
authors.affiliation: Department of Neuroendovascular Therapy, Tokyo Metropolitan Police Hospital, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sato
authors.affiliation: Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Kyouske
authors.initials: K
authors.lastname: Tsutsumi
authors.affiliation: Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Murao
authors.affiliation: Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ide
mesh_terms: D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D002941:Circle of Willis / Q000503:physiopathology; D003097:Collateral Circulation; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D020768:Middle Cerebral Artery / Q000503:physiopathology; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome