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Asymptomatic subarachnoid hemorrhage following carotid endarterectomy: illustrative case
Shin Nemoto1,2, Takuma Maeda2, Keiichi Yamashita1
11Department of Neurosurgery, Mito Brain Heart Center, Mito, Ibaraki, Japan; and.
Insights
A rare case of non-aneurysmal subarachnoid hemorrhage (SAH) occurred after carotid endarterectomy (CEA). This highlights the need for postoperative monitoring and strict blood pressure control to prevent complications.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Carotid endarterectomy (CEA) and stenting treat internal carotid artery stenosis.
- Cerebral hyperperfusion syndrome (CHS) is a known complication, potentially causing hemorrhage.
- Non-aneurysmal subarachnoid hemorrhage (SAH) is a rare but serious complication.
Purpose of the Study:
- To report a rare case of non-aneurysmal SAH following CEA.
- To review the literature on this complication.
- To emphasize the importance of postoperative monitoring and management.
Main Methods:
- A case report of a 70-year-old woman with severe carotid stenosis undergoing CEA.
- Postoperative care included strict blood pressure control and monitoring for CHS.
- Follow-up MRI was used to assess for SAH progression.
Main Results:
- The patient developed an asymptomatic SAH on postoperative day 7.
- No evidence of CHS was observed.
- Follow-up MRI showed no enlargement of the SAH, and the patient was discharged with a modified Rankin scale score of 0.
Conclusions:
- Non-aneurysmal SAH is a rare complication of CEA, even in asymptomatic individuals.
- Postoperative MRI is essential for detecting SAH after CEA.
- Meticulous blood pressure control post-CEA is critical regardless of symptoms.
Background:
Carotid endarterectomy (CEA) and carotid artery stenting are common surgical interventions for internal carotid artery stenosis. Cerebral hyperperfusion syndrome (CHS) is a well-known complication of both procedures that can lead to intracranial hemorrhage and worsen clinical outcomes. Here, the authors report a rare case of non-aneurysmal subarachnoid hemorrhage (SAH) following CEA and review the relevant literature.
Observations:
A 70-year-old woman with hypertension and diabetes presented with progressive visual loss in the right eye and was diagnosed with ocular ischemic syndrome. Imaging revealed severe right cervical carotid artery stenosis. CEA was performed with no complications. Postoperatively, the patient's blood pressure was tightly controlled, with no evidence of CHS. However, an asymptomatic SAH was detected on postoperative day 7. Careful observation and blood pressure control were maintained. Since follow-up magnetic resonance imaging (MRI) showed no enlarging of the SAH and the patient was asymptomatic, she was discharged on postoperative day 15 with a modified Rankin scale score of 0.
Lessons:
This case highlights the potential occurrence of non-aneurysmal SAH as a rare complication of CEA, even in asymptomatic patients. Repeated postoperative MRI is necessary to detect such complications. It is crucial to carefully control blood pressure after CEA regardless of symptoms.
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