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To the Editor:We read with interest the article by McDonald et al1 and the accompanying editorial from the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) investigators regarding the higher incidence of intracranial hemorrhage (ICH) in patients undergoing carotid angioplasty and stenting (CAS) compared with endarterectomy for carotid stenosis. The rate of ICH in symptomatic patients undergoing CAS was 4.4%. The mechanism of postrevascularization ICH is thought to be cerebral hyperperfusion arising from baroreceptor dysregulation of cerebral blood flow. It has been postulated that balloon angioplasty and stenting stretches and “uniquely stuns” the carotid …

stroke

Letter by Pelz and Lownie Regarding Article, “Intracranial Hemorrhage Is Much More Common After Carotid Stenting Than After Endarterectomy: Evidence From the National Inpatient Sample”