Contralateral hyperacute intracerebral hemorrhage after carotid artery stenting with contralateral internal carotid artery occlusion Hirokazu Takami,

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Contralateral hyperacute intracerebral hemorrhage after carotid artery stenting with contralateral internal carotid artery occlusion Hirokazu Takami, MD, Kazuo Hanakawa, MD, Hiroaki Sato, MD, Kyouske Tsutsumi, MD, Masahiko Murao, MD, Takafumi Ide, MD Journal of Vascular Surgery Volume 59, Issue 3, Pages 821-824 (March 2014) DOI: 10.1016/j.jvs.2013.04.051 Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 1 Preoperative and intraoperative angiography and magnetic resonance imaging findings. A, Angiography image (lateral view) of the right carotid artery bifurcation shows occlusion of the right cervical internal carotid artery (ICA). B, Angiography image (lateral view) of the left carotid artery bifurcation shows severe stenosis of the ICA. This was a 78% stenosis according to the criteria of the North American Symptomatic Carotid Endarterectomy Trial. C, Digital subtraction image (lateral view) of the intracranial circulation during right common carotid artery injection shows blood flow from the external carotid artery to the cavernous portion of the right ICA through the right middle meningeal artery and the right ophthalmic artery. D, Digital subtraction image (anteroposterior view) of the intracranial circulation during left common carotid artery injection shows cross-flow through the anterior communicating artery to the right hemisphere and perfusion of part of the territory of the right anterior cerebral artery. E, Magnetic resonance angiography image (inferior view) shows poor flow in the right middle cerebral artery, despite visualization of the posterior communicating artery. F, Angiography image (lateral view) of the left carotid artery bifurcation after stent placement and dilatation shows nearly total resolution of the stenosis. G, Digital subtraction image (anteroposterior view) of the intracranial circulation during left common carotid artery injection shows increased cross-flow through the anterior communicating artery and increased flow in the right middle cerebral artery. Journal of Vascular Surgery 2014 59, 821-824DOI: (10.1016/j.jvs.2013.04.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 2 Graph shows systolic and diastolic blood pressure (BP) during and after the stenting procedure. CT, Computed tomography; ICU, intensive care unit. Journal of Vascular Surgery 2014 59, 821-824DOI: (10.1016/j.jvs.2013.04.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

Fig 3 A, Axial computed tomography (CT) image at 50 minutes after stent deployment shows a small amount of hemorrhage in the right frontal lobe near the cortex. B, Axial CT image at 3 hours after the previous examination shows extension of the hematoma to a maximum diameter of 61 mm. C, Axial CT image after craniotomy shows almost all of the hematoma was evacuated. Journal of Vascular Surgery 2014 59, 821-824DOI: (10.1016/j.jvs.2013.04.051) Copyright © 2014 Society for Vascular Surgery Terms and Conditions