Following carotid revascularization with either carotid endarterectomy or stenting, the impaired cerebral autoregulation can lead to cerebral hyperperfusion syndrome. This impaired autoregulation and increased flow may also put patients with unruptured aneurysms at risk for subarachnoid hemorrhage in the perioperative period. A patient is reported who underwent carotid endarterectomy for symptomatic carotid stenosis. A small anterior communicating artery aneurysm was identified preoperatively, which ruptured 2 days after carotid endarterectomy. Screening for cerebral aneurysms prior to carotid revascularization will allow operators to minimize this risk, either through prior treatment of the aneurysm or tight blood pressure control in the perioperative period.

We do occasionally see intracranial aneurysms associated with carotid artery stenosis.

And, we leave then alone....while reopening the stenosis.

However, this case shows that this approach is not without vice...