Risk, types, and severity of intracranial hemorrhage in patients with symptomatic carotid artery stenosis

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Updated: Sep 23, 2026

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
09:36

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

Raymond T F Cheung1, Michael Eliasziw, Heather E Meldrum

  • 1University Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong King, China. rtcheung@hkucc.hku.hk

Stroke
|June 28, 2003
PubMed

Insights

Intracranial hemorrhage is uncommon in carotid artery stenosis patients but carries high risks. Risk factors differ significantly between medical and surgical treatments, impacting patient outcomes.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Clinical Epidemiology

Background:

  • Internal carotid artery stenosis poses risks for stroke and intracranial hemorrhage.
  • Long-term follow-up data is crucial for understanding these risks.

Purpose of the Study:

  • To determine the incidence and risk factors of intracranial hemorrhage.
  • To compare outcomes in patients with and without carotid endarterectomy.

Main Methods:

  • Analysis of prospective data from the North American Symptomatic Carotid Endarterectomy Trial.
  • Kaplan-Meier curves for 30-day and 5-year risks of petechiae within infarction (PTI) or intracerebral hematoma (ICH).
  • Cox proportional-hazards regression for risk factor identification.

Main Results:

  • Intracranial hemorrhage occurred in 749 of 2885 patients (24 PTIs, 14 ICHs, 1 SAH) over 5 years.
  • 5-year risk was 1.7% for both groups; 30-day risk was higher in surgical patients (0.64% vs 0.07%).
  • Risk factors varied: hypertension, smoking, age for medical; diabetes for surgical.

Conclusions:

  • Intracranial hemorrhages are infrequent but severe complications in carotid artery stenosis.
  • Distinct risk factors exist for medically versus surgically treated patients.
  • Understanding these differences is key for managing patients with carotid artery stenosis.
Abstract

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