Document Detail

Intracranial hemorrhage after stenting and angioplasty of extracranial carotid stenosis.
MedLine Citation:
PMID:  11110546     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: The transluminal angioplasty and stenting procedure has been recently advocated as a potential alternative to surgical endarterectomy for the treatment of severe extracranial carotid stenosis. This study assesses the incidence and significance of intracranial hemorrhage occurring after this procedure. METHODS: We retrospectively reviewed 104 carotid arteries (96 internal, two external, and six common) in 90 patients (63 male; mean age, 69.4 years; range, 48-88 years) who underwent primary stenting and angioplasty by use of Wallstents (103/104) at three centers between January 1996 and January 1999. Seventy-five (83%) patients were referred by neurosurgery departments. Seventy-one (68%) arteries were symptomatic; the mean stenosis percentage was 85% (range, 40-99%). RESULTS: Four intraparenchymal hemorrhages occurred, representing 4.4% of patients and 3.8% of vessels, after angioplasty and stent placement. The mean preoperative stenosis percentage was 95% (range, 90-99%). One hemorrhage occurred immediately after stent placement, whereas the three other hemorrhages occurred in a delayed fashion (mean, 2.8 days). The mean hematoma size was 4.8 cm (range, 2-8 cm). Three patients had associated subarachnoid or intraventricular bleeding; the fourth had associated subdural hemorrhage. Three hemorrhages were fatal; the fourth experienced two seizures only. No acute neurologic symptoms were present prior to hemorrhages, and there was no postprocedural hypertension in these patients. All had been receiving antiplatelet agents as well as intraprocedural IV heparin. CONCLUSION: Intracranial hemorrhage can occur after carotid angioplasty and stenting. We speculate that this represents cerebral hyperperfusion injury. The 3.8% incidence of cerebral hemorrhage observed is approximately sixfold greater than that reported post endarterectomy (0.6%) (95% CI, 0.2-8.7%). This is not statistically significant in this small study group. This trend may reflect patient selection, different anticoagulation protocols, and/or study population size. Additional data are needed to determine the safety and efficiency of carotid stenting as a treatment for carotid stenosis.
W Morrish; S Grahovac; A Douen; G Cheung; W Hu; R Farb; P Kalapos; R Wee; M Hudon; C Agbi; M Richard
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  21     ISSN:  0195-6108     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:    2000 Nov-Dec
Date Detail:
Created Date:  2001-03-22     Completed Date:  2001-05-31     Revised Date:  2008-02-14    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1911-6     Citation Subset:  IM    
Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Alberta, Canada.
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MeSH Terms
Aged, 80 and over
Angioplasty, Balloon / adverse effects*
Carotid Stenosis / radiography,  therapy*
Intracranial Hemorrhages / etiology*,  radiography
Middle Aged
Retrospective Studies
Stents / adverse effects*
Tomography, X-Ray Computed
Comment In:
AJNR Am J Neuroradiol. 2002 Mar;23(3):503-4   [PMID:  11901031 ]

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