Multiple intra-cranial hemorrhages after carotid endarterectomy

Intra-cerebral hemorrhage is an unusual and often fatal complication of endarterectomy (CEA). Previous cerebral infarction, intra-operative or post operative hypertension, and the use of anti-coagulants are some of the defined major risk factors. Hemorrhage usually occurs early after CEA, and a second hemorrhage has only once been reported. We wish to report a patient who developed three separate hemorrhages following CEA. This patient had a long history of poorly controlled hypertension. We believe that poorly controlled hypertension, in addition to other reported factors, may be an important separate risk factor for post-CEA hemorrhage.