Skip to main content
Log in

The Incidence of Ischemic Stroke versus Intracerebral Hemorrhage after Carotid Endarterectomy: A Review of 2452 Cases

  • Clinical Research
  • Published:
Annals of Vascular Surgery

Abstract

Carotid endarterectomy is a frequently performed vascular procedure. The most common major perioperative neurologic complication is ischemic stroke. Intracerebral hemorrhage has been traditionally viewed as less common. It has been recently proposed that as technical advances are made, the rate of ischemic stroke and other complications has decreased, causing hemorrhagic stroke to attain increasing importance as a perioperative complication. A review of 2452 consecutive endarterectomies performed by a single surgeon from 1983 to 2000 was performed and rates of ischemic and hemorrhagic strokes were analyzed. There were five hemorrhagic strokes for a rate 0.20% (13.5% of postoperative neurologic complications) and 32 with ischemic strokes for a rate of 1.31% (86.5% of postoperative neurologic complications). From these data we conclude that hemorrhagic stroke remains uncommon and ischemic stroke continues to be the most frequent cause of postoperative neurologic complication after carotid endarterectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. DC Hsia LM Moscoe WM Krushat (1998) ArticleTitleEpidemiology of carotid endarterectomy among Medical beneficiaries: 1985-1996 update Stroke 29 346–350 Occurrence Handle9472872 Occurrence Handle1:STN:280:DyaK1c7jt1aitg%3D%3D

    PubMed  CAS  Google Scholar 

  2. InstitutionalAuthorNameNorth American Symptomatic Carotid Endarterectomy Trial Collaborators. (1991) ArticleTitleBeneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis N Eng J Med 325 445–453 Occurrence Handle10.1056/NEJM199108153250701

    Article  Google Scholar 

  3. InstitutionalAuthorNameExecutive Committee for the Asymptomatic Carotid Atherosclerosis Study. (1995) ArticleTitleEndarterectomy for asymptomatic carotid artery stenosis JAMA 273 1421–1428 Occurrence Handle10.1001/jama.273.18.1421

    Article  Google Scholar 

  4. NR Hertzer PJ O’Hara EJ Mascha et al. (1997) ArticleTitleEarly outcome assessment for 2228 consecutive carotid endarterectomy procedures: the Cleveland Clinic experience from 1989 to 1995 J Vasc Surg 26 1–10 Occurrence Handle1:STN:280:DyaK2szosVKntA%3D%3D Occurrence Handle9240314 Occurrence Handle10.1016/S0741-5214(97)70139-3

    Article  CAS  PubMed  Google Scholar 

  5. JD Easton DG Sherman (1977) ArticleTitleStroke and mortality rate in carotid endarterectomy: 228 consecutive operations Stroke 8 565–568 Occurrence Handle906055 Occurrence Handle1:STN:280:DyaE1c%2FhsVGlsg%3D%3D

    PubMed  CAS  Google Scholar 

  6. K Ouriel CK Shortell KA Illig et al. (1999) ArticleTitleIntracerebral hemorrhage after carotid endarterectomy: incidence, contribution to neurologic morbidity, and predictive factors J Vasc Surg 29 82–89 Occurrence Handle9882792 Occurrence Handle10.1016/S0741-5214(99)70362-9 Occurrence Handle1:STN:280:DyaK1M7gt1aktQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. ME Bruetman WS Fields ES Crawford et al. (1963) ArticleTitleCerebral hemorrhage in carotid artery surgery Arch NeuroI 147 458–467

    Google Scholar 

  8. RA Solomon CM Loftus DO Quest et al. (1986) ArticleTitleIncidence and etiology of intracerebral hemorrhage following carotid endarterectomy J Neurosurg 64 29–34 Occurrence Handle3941347 Occurrence Handle1:STN:280:DyaL28%2FovVWhug%3D%3D Occurrence Handle10.3171/jns.1986.64.1.0029

    Article  PubMed  CAS  Google Scholar 

  9. DG Piepgras MK Morgan TM Sundt SuffixJr et al. (1988) ArticleTitleIntracerebral hemorrhage after carotid endarterectomy J Neurosurg 68 532–536 Occurrence Handle3351580 Occurrence Handle1:STN:280:DyaL1c7ntFKltQ%3D%3D

    PubMed  CAS  Google Scholar 

  10. HB Reith M Edelmann C Reith (1992) ArticleTitleSpontaneous intracerebral hemorrhage following carotid endarterectomy. Experience of 328 operations from 1983-1988 Int Surg 77 224–225 Occurrence Handle1399375 Occurrence Handle1:STN:280:DyaK3s%2FhsVKmsw%3D%3D

    PubMed  CAS  Google Scholar 

  11. J Golledge M Ellis T Sabharwal et al. (1999) ArticleTitleSelection of patients for carotid endarterectomy J Vasc Surg 30 122–130 Occurrence Handle10394162 Occurrence Handle10.1016/S0741-5214(99)70184-9 Occurrence Handle1:STN:280:DyaK1MzisVSrsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  12. ME DeBakey (1975) ArticleTitleSuccessful carotid endarterectomy for cerebrovascular insufficiency. Nineteen-year follow-up JAMA 233 1083–1085 Occurrence Handle10.1001/jama.233.10.1083 Occurrence Handle1:STN:280:DyaE28%2Fgslyktg%3D%3D Occurrence Handle1174155

    Article  CAS  PubMed  Google Scholar 

  13. HH Eastcott GW Pickering CG Rob (1954) ArticleTitleReconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia Lancet 267 994–996 Occurrence Handle10.1016/S0140-6736(54)90544-9 Occurrence Handle1:STN:280:DyaG2M%2FisVOlsA%3D%3D Occurrence Handle13213095

    Article  CAS  PubMed  Google Scholar 

  14. EJ Wylie MF Hein JE Adams (1964) ArticleTitleIntracranial hemorrhage following surgical revascularization for treatment of acute strokes J Neurosurg 21 212–215 Occurrence Handle14127622 Occurrence Handle1:STN:280:DyaF2c%2FosFeksQ%3D%3D Occurrence Handle10.3171/jns.1964.21.3.0212

    Article  PubMed  CAS  Google Scholar 

  15. JA DeWeese CG Rob R Satran et al. (1968) ArticleTitleSurgical treatment for occlusive disease of the carotid artery Ann Surg 168 85–94 Occurrence Handle5673203 Occurrence Handle1:STN:280:DyaF1czpvVyitA%3D%3D Occurrence Handle10.1097/00000658-196807000-00010

    Article  PubMed  CAS  Google Scholar 

  16. JE Thompson MM Kartchner DJ Austin et al. (1966) ArticleTitleCarotid endarterectomy for cerebrovascular insufficiency (stroke): follow-up of 359 cases Ann Surg 163 751–763 Occurrence Handle5930458 Occurrence Handle1:STN:280:DyaF287itlejuw%3D%3D

    PubMed  CAS  Google Scholar 

  17. FB Meyer TM Sundt SuffixJr DG Piepgras et al. (1986) ArticleTitleEmergency carotid endarterectomy for patients with acute carotid occlusion and profound neurological deficits Ann Surg 203 82–89 Occurrence Handle3942424 Occurrence Handle10.1097/00000658-198601000-00014 Occurrence Handle1:STN:280:DyaL287gt1arsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  18. WF Blaisdell RH Clauss JG Galbraith et al. (1969) ArticleTitleJoint study of extracranial arterial occlusion. IV. A review of surgical considerations . JAMA 209 1889–1895 Occurrence Handle10.1001/jama.209.12.1889 Occurrence Handle5820077 Occurrence Handle1:STN:280:DyaF1M3nsFOjtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  19. InstitutionalAuthorNameNorth American Symptomatic Carotid Endarterectomy Trial Collaborators. (1998) ArticleTitleBenefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis N Engl J Med 339 1415–1425 Occurrence Handle10.1056/NEJM199811123392002

    Article  Google Scholar 

  20. JE Thompson RD Patman CM Talkington (1978) ArticleTitleAsymptomatic carotid bruit: long-term outcome of patients having endarterectomy compared with unoperated controls Ann Surg 188 308–316 Occurrence Handle686896 Occurrence Handle1:STN:280:DyaE1c3lsFyhsg%3D%3D Occurrence Handle10.1097/00000658-197809000-00005

    Article  PubMed  CAS  Google Scholar 

  21. RW Hobson Suffix2nd DG Weiss WS Fields et al. (1993) ArticleTitleEfficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veteran Affairs Cooperative Study Group N Engl J Med 328 221–227 Occurrence Handle10.1056/NEJM199301283280401 Occurrence Handle8418401

    Article  PubMed  Google Scholar 

  22. GA Mansoor WB White M Grunnet et al. (1996) ArticleTitleIntracerebral hemorrhage after carotid endarterectomy associated with ipsilateral fibrinoid necrosis: a consequence of the hyperperfusion syndrome? J Vasc Surg 23 147–151 Occurrence Handle8558730 Occurrence Handle10.1016/S0741-5214(05)80045-X Occurrence Handle1:STN:280:DyaK287lt1ensA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  23. C Jansen AM Sprengers FL Moll et al. (1994) ArticleTitlePrediction of intracerebral hemorrhage after carotid endarterectomy by clinical criteria and intraoperative transcranial Doppler monitoring Eur J Vasc Surg 8 303–308 Occurrence Handle7912206 Occurrence Handle10.1016/S0950-821X(05)80146-X Occurrence Handle1:STN:280:DyaK2c3otlKnuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alex D. Ammar MD.

About this article

Cite this article

Wilson, P.V., Ammar, A.D. The Incidence of Ischemic Stroke versus Intracerebral Hemorrhage after Carotid Endarterectomy: A Review of 2452 Cases. Ann Vasc Surg 19, 1–4 (2005). https://doi.org/10.1007/s10016-004-0131-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10016-004-0131-5

Keywords

Navigation