Fatal Subarachnoid Hemorrhage After Early Carotid Stenting For Progressive Stroke: Case Report / 대한뇌혈관외과학회지

ABSTRACT

Subarachnoid hemorrhage (SAH) after surgical or interventional treatment for carotid stenosis is rare, with only a few cases reported in the literature. Our department treated a 78-year-old female with symptoms of deteriorated mental functioning and focal neurological signs. Despite medical treatment, serial magnetic resonance imaging (MRI) studies revealed a progressive extension of multiple infarctions in her left cerebral hemisphere. Cerebral angiography revealed greater than 95% stenosis in the proximal left internal carotid artery (ICA), accompanied by multiple stenoses of the contralateral ICA. For this progressive stroke, we performed early carotid stenting in the left ICA stenosis. Two hours after the procedure, the patient suddenly collapsed, and a computed tomography (CT) scan showed a diffuse SAH with acute hydrocephalus. Despite medical and surgical treatment, the patient died six days after the procedure. The case presented here and a review of the reports on the previous instances suggest that long-standing, severe carotid stenosis with contralateral multiple severe stenoses, persistent hypertension, and the extensive use of heparin and antithrombotic agents may predispose patients to SAH.