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

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.