Hyperacute Intracerebral Hemorrhage Complicating Carotid Stenting Should Be Distinguished from Hyperperfusion Syndrome
J.-H. Buhka,
L. Cepekb and
M. Knautha
a Department of Neuroradiology, University Hospital Goettingen, Germany
b Department of Neurology, University Hospital Goettingen, Germany
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Fig. 1. MR imaging before CAS.
A–C, Lesion of focally restricted diffusion in the right-sided centrum semiovale, characteristic of acute hemodynamic infarction (A, diffusion-weighted MR imaging [DWI][; B, apparent diffusion coefficient [ADC]). In the FLAIR sequence, an incomplete demarcation can be seen (C).
D–F, At the level of the basal ganglia there is no evidence of an acute ischemic lesion. The right occipital pole is part of the residual posterior territorial infarction. The FLAIR sequence demonstrates mild microangiopathic changes (F).
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Fig. 2. A maximum intensity projection (MIP) image reconstructed from CT-angiographic data shows the high-grade stenosis of the right ICA as well as associated calcified atherosclerotic plaques (A). Digital subtraction angiography of the right carotid bifurcation before and after the intervention shows a tight, short-segment, hemodynamically significant stenosis (B, closed arrow)—note the low attenuation of contrast medium in ICA distal to the stenosis (B, open arrow)—and a good hemodynamic result after stent-placement and dilation (C).
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Fig. 3. Unenhanced cranial CT from approximately 1 hour after the intervention demonstrates a large right basal ganglial hemorrhage with extension to intra-axial and extra-axial CSF spaces. The hematoma is ipsilateral to the treated stenosis. The uppermost section shows the residual lesion after previous infarction in the right PCA territory.
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