Intracranial Hemorrhage after Stenting and Angioplasty of Extracranial Carotid Stenosis
William Morrisha,
Stephen Grahovaca,
Andre Douena,
Gordon Cheunga,
William Hua,
Richard Farba,
Paul Kalaposa,
Roberto Weea,
Mark Hudona,
Charles Agbia and
Michael Richarda
a From the Department of Diagnostic Imaging (W.M., W.H., M.H.), Foothills Medical Centre, University of Calgary; the Department of Radiology (S.G., P.K., R.W.), and Divisions of Neurology (A.D.) and Neurosurgery (C.A., M.R.), The Ottawa Hospital, University of Ottawa; and Department of Radiology (G.C., R.F.), Sunnybrook Health Science Center, University of Toronto.
b Address reprint requests to William F. Morrish, Dept. of Diagnostic Imaging, Foothills Medical Centre, 1403-29 Street N.W., Calgary, Alberta Canada T2N 2T9.
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FIG 1. Patient 2. A, Ninety percent right internal carotid artery stenosis.
B, Postoperative angiogram shows a 30% residual stenosis post stenting.
C, CT of head at discharge shows an old, right, parietal infarct.
D, CT head 2 days postoperatively depicts a large, right, frontal hematoma with a small subdural hematoma.
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FIG 2. Patient 3. A, Ninety-nine percent right internal carotid artery stenosis. A left external carotid stent is also visualized. The left internal carotid artery is occluded.
B, Postprocedural angiogram with no significant residual stenosis post angioplasty and stenting.
C, CT of head 6 days postoperatively reveals an acute frontal hematoma with associated subarachnoid hemorrhage. The patient was clinically well until he experienced a generalized seizure approximately 2 hours prior to the CT scan.
D, Two-week follow-up reveals marked resolution of hemorrhage.
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FIG 3. Patient 4. A, Ninety-five percent right internal carotid artery stenosis.
B, Post angioplasty and stenting with no significant residual stenosis.
C and D, Angiogram immediately post stenting demonstrates extravasation from a lenticulostriate artery (arrow). At no time during the procedure did a catheter or guidewire enter into the intracranial circulation.
E, CT of head postoperatively shows a right basal ganglia, intraventricular, and subarachnoid hemorrhage as well as hydrocephalus.
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