Patients who have critically low perfusion to a hemisphere can have what is termed as "shock brain," in which, in spite of good reperfusion of a hemisphere, the patient has a globally diminished neurologic examination for approximately 24 hr. This condition is usually limited in time, and with time, the brain function responds to the new perfusion.

Recent stroke in a patient is a relative contraindication to stent placement, because, if the stroke is large enough, reperfusion hemorrhage will occur if the territory is reperfused when the blood-brain barrier is still considered regulated to a lower perfusion pressure. The larger the territory of stroke, the more profound the repercussions of bleeding into the site and the stronger the contraindication for doing the procedure in the first place. Obviously, patient selection is performed on a case-by-case basis, with knowledge of other perfusion that the patient may or may not have had. Small lacunar infarcts can be treated in the acute setting, depending on the patient's symptoms and vascular reserve. These cases harbor more hazards, as the team performing the procedure and the team receiving the patient must be aware of the increased risks of hemorrhage. If any patient has a focal neurologic change during examination, noncontrast head computed tomography is the first study that should be performed to assess hemorrhage and/or stroke. Although the goal of neurointerventional procedures (carotid stenting or angioplasty) is to prevent stroke, stroke is the most common and most devastating complication of these procedures.

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